Improving Aging Mental Health Services in Developing Economies: A Socio-Ecological Approach

Improving Aging Mental Health Services in Developing Economies: A Socio-Ecological Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Perspective Improving Aging Mental Health Services in Developing Economies: A Socio-Ecological Approach Namrata Mukherjee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4360005/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract For older cohorts, there is decreased synergy between social determinants of health (SDoH), a sense of personal security, and knowledge about mental health conditions. The centrality of this paper is to discuss social constraints hindering the accessibility of older adults to mental health services. This paper further conceptualizes a multistakeholder socioecological model (ScEcM) with an adaptation of the social determinants of health framework and socioecological theory of human behavior. The model will aid social workers in less developed economies in tackling the stigma surrounding mental health by involving multilevel partnerships along with a focus on interpersonal constraints. This model is built by deliberating upon the role of public policies; the importance of socioecological factors such as interactions within the community and organization; and individual help-seeking behavior and other social deterrents that influence access to mental healthcare. The five stages of the model are identification, encouragement, integration, enrollment, and incentivization, which merge community-level participation with public policy and social security to counter the social elements that influence access to mental healthcare. Through a literature review, this paper introduces a fresh approach to posit a macro socioecological model that can help social workers address mental health inaccessibility in developing economies. older adults accessibility mental health socioecological model social determinants of health Figures Figure 1 Introduction Old age-specific care focusing on compromised cognition is essential for the overall well-being of people aged 65 years and older. Specialized care in old age can enable them to maintain their health and autonomy for a longer period. Additionally, the process of aging is often accompanied by a range of health and cognitive issues (Abdi et al., 2019 ). It is estimated that 5.8 million Americans have progressive cognition disease and that Alzheimer's disease and related dementias (ADRD) affect more than 55 million individuals globally, with a majority exceeding 60% residing in low- and middle-income nations. (WHO, 2023). Among older adults, approximately 10–15% suffer from symptomatic cognitive dysfunction, such as dementia, and an additional 5–10% have nonclinical symptoms. Approximately 90% of the older population who experience clinical and nonclinical symptoms does not receive the necessary treatment (Sivakumar et al., 2020 ). The prevailing knowledge gap regarding the inaccessibility of adequate mental health services for older adults experiencing cognitive decline is because a considerable amount of related research neglects the interplay of social, ecological, and policy factors that impact the older population's ability to pursue mental health care (Greysen et al., 2014 ). This has adverse consequences for physical health, life expectancy, quality of life, family, relationships, and finances, with significant public health implications (Ebrahimi et al., 2022 ). Approaching mental health for the aging population should be focused beyond the layers of clinical detection and treatment of symptoms to acknowledge the role of social aspects in mental well-being. Case managers should use a multidisciplinary care plan that looks at controlling social and structural factors influencing access to mental health for older adults (Rosen et al., 2018 ). The barriers to accessing mental health services for older adults can be understood by applying the social determinants of health (SDoH) framework, whose impact varies for each person. Structural and functional changes in social determinants of health for older adults, such as economic stability, relationships within the neighborhood and environment, healthcare access, availability of services, and perceptions of role in society, contribute significantly to their knowledge and help-seeking behavior (Pooler & Srinivasan, 2018 ). These social determinants impact the ability of the aging population to comprehend the benefits of mental health services and seek out care. Aging care plans informed by appropriately designed models that take social deterrents and ecological perspectives into account are needed to improve our mental health as we age (Joo et al., 2019 ). The purpose of this review paper is to formulate a macrolevel approach to geriatric care aimed at addressing the research question of how a socioecological model (ScEcM) can influence the accessibility of mental well-being services for older adults in less developed economies. This model aligns with socioecological theory, which outlines five main players—individual, interpersonal, organizational, community, and public policy—that influence human behavior (Bronfenbrenner,1979). The significance of this model for developing countries is to strengthen the ecology surrounding the individual and help in the assessment, monitoring, evaluation, and mitigation of the barriers to aging social determinants of health, thereby helping individuals develop better help-seeking behavior in a society that is free of stigma. To date, there has been insufficient research dedicated to mental health care for older individuals, considering the social barriers arising from the interplay of socioecological theory components. Although many studies have identified social challenges influencing healthcare access that emerge with aging, limited evidence can be found in the literature on how to reduce these challenges by engaging in partnerships at the macrolevel to develop better behavior related to seeking proper mental health care (Foong et al., 2021 ). Considering that mental health is vital to the quality of life of older adults, a socioecological model involving multiple stakeholders offers a solution to the microlevel detection of social deterrents that cause psychological distress (Cramer & Kapusta, 2017 ). This approach will enable social workers to discern older adults who do not have clinical symptoms of mental disorders but who face barriers in their social interactions. With weak social interactions and cognitive abilities among the older population, it is important to build on the lack of research conceptualizing a ScEcM so that mental health care can receive priority at multiple levels in society in order to round out geriatric care (Piolatto et al., 2022 ). Methods The purpose of this literature review was to determine how best to adapt socioecological theory to address social determinants of health. The literature review helped us to comprehend the extent of the impact of social determinants of health on mental health during our aging process. Subsequently, the proposed model utilizes the components of socioecological theory to influence the accessibility of mental health services. To design the socioecological model (ScEcM), a literature search was performed using the following set of terms: ( "geriatric" OR "elder" OR "senior citizens" OR gerontol*) AND ("mental wellbeing" OR "psychological wellbeing" OR "emotional wellbeing" OR "wellbeing" OR " mental health") AND ("[social determinants of health" OR "economic stability" OR "education access" OR "education quality" OR "quality of education" OR "healthcare access" OR "healthcare quality" OR "quality of healthcare" OR "neighborhood environment" OR "built environment" OR "social context" OR "community context" OR "help seeking behavior" OR "public policy") AND ("access to care" OR "access to healthcare" OR "access to services" OR "accessibility" OR access*)). The seven databases that were used were PUBMED, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, APA PsycINFO, the Web of Science, Social Work Abstracts, the Academic Search Complete, and SCOPUS. These search terms were carefully designed to encompass elements of socioecological theory when viewed through social determinants of the health framework. The literature review aimed to comprehend accessibility and its influencing factors by examining practices in countries with robust healthcare systems. The goal was to devise a model that aids practitioners in organizing aging care in nations with limited access to mental health and geriatric well-being services. Due to the lack of concentrated research focused on socioecological perspectives influencing social determinants of health, it was necessary to include both quantitative and qualitative studies to be able to capture a majority of unique discussions on this topic. The inclusion of articles specific to the USA and Europe was focused on because of the robustness of these healthcare structures. The population in the study was kept open to the 65 + year age bracket because the components of social relationships have been found to influence the mental health of the geriatric population right from their retirement stage, and this influence progresses with age (Wickramaratne et al., 2022 ). It was important to maintain the focus of the study on social and ecological aspects associated with healthy aging and exclude studies that dealt with mental health screening and treatment in depth from a medical perspective. The literature search provided substantial evidence to support the claim that there is a lack of literature dealing with the socioecological aspects of older adults that can influence their mental health accessibility. Most of the related studies have shown the social determinants of health framework to be critical for understanding the accessibility of mental health; however, most have failed to connect these factors to socioecological factors that influence human behavior. The intersection of aging care, the challenges faced by older adults with their experiences with policies, social support, community interactions, and patterns of help-seeking behavior is a fresh topic for understanding this problem. Combining Social Determinants of Health Frameworks with Socioecological Theory The scope of the conceptual paper enabled us to explore a well-analyzed and frequently used framework of social determinants of health in geriatric research and gerontology. Since March 2005, the social determinants of health (SDoH) framework has been used to understand the problems associated with health access and assemble scientific evidence to change policy and practices related to healthcare management (Irwin & Scali, 2007 ). Newell ( 1975 ) explained the importance of robust engagement with the social dimensions of health that allowed us to understand the causes of health problems emerging within society. Any approach related to access to healthcare services from a strict health sectoral approach will be ineffective because the causes lie within society and outside the fields of healthcare systems (Newell, 1975 ). This also holds true in the case of mental health accessibility in geriatric care. With the diminished cognitive abilities and difficulties faced by older adults in interactions with the social determinants of health, effective geriatric care management can be achieved only by tackling the social challenges that hinder access. With increasing age at retirement, the ability to pay for healthcare services gradually declines for older adults. The loss of cognitive abilities and perceptions of losing value within society impact individuals’ ability to strengthen social connectedness (Poey et al., 2017 ). The SDoH framework is especially crucial for crafting a model that concentrates on pinpointing societal issues deeply linked to impeding access to mental health in the management of geriatric care. Black and colleagues ( 1980 ) discussed in a report that addressing health disparities linked to access necessitates social policy interventions concentrating on healthcare service delivery. This involves identifying social issues and discrimination that directly impede certain individuals' access to appropriate healthcare facilities. A multistakeholder model that uses community-level strategies through a mix of direct investments in communities and collaboration through multisector partnerships (Gottlieb et al., 2019 ) can improve the conditions of social determinants associated with healthcare access. Elements such as social connections, the presence of healthcare services, well-designed public policies, community engagement, and income fairness should be considered when formulating any model to address challenges related to accessing mental health services (Holt-Lunstad et al., 2017 ). The neoliberal health sector reforms (HSR) of the 1980s and 1990s aimed to address structural problems in health systems and poor systems management by proposing to take into account the impact of social determinants in designing sustainable frameworks and models that understand healthcare inaccessibility from the nuances of the role of a strong social structure (Irwin & Scali, 2007 ). This strongly confirms the necessity of adapting the SDoH framework to investigate health and well-being issues in geriatric care. The findings also underscore the importance of designing models that target interventions targeting the social and ecological factors that hinder access to mental health. Socioecological theory should be developed where several social factors need to be identified as potentially modifiable targets for intervention (Pavon et al., 2021 ). The socioecological model (ScEcM) is adapted from the socioecological theory of human behavior (Bronfenbrenner, 1979 ), which helps in the assessment, monitoring, evaluation, and mitigation of the barriers to social determinants of health. The SDoH acts as a key mediator among the various elements individuals engage within society when constructing any model intended to tackle healthcare access challenges. Utilizing the SDoH framework to establish a ScEcM is beneficial for examining literature evidence that underscores the significance of intrapersonal relationships for older adults and how this reliance influences their access to a high quality of life. Evidence of the Problem 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. Development of a Socioecological Model Aging is a gradual process, but the aim of aging interventions should be focused on supporting older adults by involving multiple sectors to address social determinants. Basic mental care services can be provided to older adults through the coalescence of public policy mechanisms and complex social and intrapersonal relationships within the ecosystem. This can be achieved by advancing the challenges of accessing mental health through the use of a macrolevel socioecological intervention mechanism. The model is designed keeping in mind the viability of on-ground implementation by practitioners in nations with poor access to mental health for the geriatric population and engaging multiple players who are responsible for the social determinants of health. This model can be used for handling multiple deterrents together along with replicating it for a geriatric population of lower- and middle-income groups to encourage access to mental health. The five intervention levels of this socioecological model are identifying, encouraging, integrating, enrolling, and incentivizing. Each of these five levels has a unique ability to encompass the players of socioecological theory in tackling social determinants of health. The following paragraphs outline the various ways in which the model can be applied to provide better mental health outcomes for older adults. The visualization of the model is provided below (see Fig. 1). Identify It is essential to identify the challenges faced by older adults in multidimensional interactions within the social determinants of health. The family, community, health practitioner, and organization to which older adults belong should acknowledge the challenges and focus on fast and streamlined identification of social considerations. Recent studies have revealed older adults' access to mental health services through individual-centric support systems within their familial and social circles (Perez et al., 2022 ). This will enable older adults to garner confidence and minimize inequality of life opportunities such as mental health care, which is associated with social stratification. The identification process should be focused on encouraging recounts of personal challenges, whether that includes struggling with the ability to pay, building social connections, etc. (Chen et al., 2022 ). The concept of social prescribing has been found to yield positive results in promoting better accessibility (Bickerdike et al., 2017 ). This mode of delivery for identification of social determinants of health should be at the community level to channel sensitization about the social stratification and eradicate stigma associated with mental health care. Encourage As identified from the literature, there is a lack of acceptance of support by many older adults that is available through health care providers. The main reason for this absence of help-seeking behavior can be attributed to the fear of shunning from one’s family, friends, and other interpersonal relationships that people assume will be associated with mental illness (Subu et al., 2021 ). It is very important to focus on the issue of mental well-being and physical well-being for people older than 65 years of age by encouraging dialogs within the family. Human behavior is heavily influenced by the systems around an individual, and the behavior of older adults actively seeking help can be enhanced when they can find support from the social relationships that an older person has as they age (Rook & Charles, 2017 ). The family is usually the primary caregiver, and any ScEcM member should anchor upon family support to ensure that the geriatric population approaches quality mental health care (Wallace & Sterns, 2022 ). These dialogs can be better channeled in the presence of a geriatric care manager who can explain the importance of mental well-being in collective quality of life (Reynolds et al., 2022 ). The acceptance of the issue within the primary circle of the aging individual will garner an increased level of confidence and better support systems for the individual. Integrate Structured policies that are focused on the concept of parity among all strata of the older population should be designed. Due to the high out-of-pocket expense of accessing mental healthcare for people in low- and middle-income groups, conditional coverage in health insurance and economic burdens contribute to most of the older population not seeking mental healthcare (Rowan et al., 2013 ). This results in a higher detection rate and treatment of psychological disorders among the population with the ability to pay, creating inequity within the geriatric population. To tackle the stigma around mental health in developing economies, it is imperative to design initiatives that forge partnerships with policy and healthcare systems to address socioeconomic inequity (Stuart, 2016 ). Practitioners must provide the impetus to policymakers to structure strong policies that are inclusive and acknowledge economic segregation to make mental health accessible to all sections of the older population (Tur-Sinai, 2022 ). The integration of parity should be prioritized when designing healthcare policies for older adults. Enroll Public policy can be considered the major contributing variable in making structured healthcare accessible for the older population. However, the process of enrollment can be challenging for some people because of their educational or economic background. It is important to integrate the enrollment process into structured policies in an easy and efficient manner (Reynolds et al., 2022 ). The role of the practitioner will be to enable effective communication of available schemes and connect them to healthcare opportunities. In developing economies, mental health inaccessibility among older adults emerges from barriers to knowledge and the lack of outreach resources about mental health policies (Dombou et al., 2023 ). Proper guidance throughout the enrollment process, multiple channels of dissemination of information, and effective dialogs will warrant better outreach and coverage (Brownson et al., 2018 ). With coherent and comprehensive enrollment and coverage of public health schemes, older adults seeking mental health support in developing economies are expected to experience higher incidences (Chen & Zhao, 2023 ). Media and advertisement agencies are among the media that practitioners can use for the implementation of this intervention. Incentivize The literature review suggests that many of the organizational healthcare schemes do not cover mental healthcare adequately or completely ignore it. Changes in the organizational operating structure cannot be enforced through aging policies. The lack of identification of inaccessibility to mental healthcare among the older population is an area of concern (Coombs et al., 2021 ). The role of the practitioner will be to propagate the change in outlook through society-level acknowledgment of the importance of mental well-being for older adults (Banerjee et al., 2021 ). A recent meta-analysis revealed that greater outcomes of seeking mental health services are associated with greater organizational insurance coverage and greater organizational commitment to improving the health outcomes of employees (Khazanov et al., 2022 ). By recognizing the contributions of older adults to the organizations they are associated with, practitioners can strategize with organizations to design health benefits that cover mental health care. Organizations or the work environment of older adults can come to the forefront of making mental health accessible and affordable by offering stable medical aid and concentrating on retirement benefits that cover mental protection care (Reynolds et al., 2022 ). This behavioral change within the system is proposed to be inculcated through a reward mechanism to organizations that provide better retirement health plans and insurance plans that cover mental health care for the aging population. This five-step socioecological model will enable practitioners to propagate policy-level acknowledgment of the social challenges associated with aging. Social work and public health practitioners should try to incorporate the model on cross-sectoral engagement levels involving family and friends, policy think tanks, organizations that older adults were/are associated with and the community at large. Each intervention is independent of the other but mediates the recognition of the elements of socioecological theory. All of these interventions can work together to address the challenges of social determinants of health in older adults, develop better help-seeking behavior, and understand the importance of mental well-being. Future Scope The ScEcM is proposed to be the beginning of approaching geriatric care by maintaining a focus on social and ecological aspects associated with aging. There is a need for concrete evidence-based research on social action, and this propels the scope for undertaking future research from the focal point of educational status, geography, income and standard of living, belief systems, and gender. The study briefly addresses the importance of introducing parity in healthcare services and public policies for all economic strata. The impact of income on accessibility can be explored further to determine the effectiveness of this model. The ScEcM can be interpreted as an introductory model to make mental healthcare accessible to the geriatric population. It also does not explore the execution of the model in urban versus rural settings of population demography. The effectiveness of the model across all demographic factors can be explored in subsequent research. Future research may also focus on understanding the specifics of the lack of accessibility to different groups within this age bracket. Conclusion There is an urgent need to comprehend the social intricacies linked to the aging process and its impact on mental health access. The socioecological model is tailored for professionals who have gained an understanding of the barriers that hinder accessibility. Its purpose is to bring together various interventions aimed at engaging multiple stakeholders to maximize participation. By involving different individuals and promoting social prescribing, society can become more aware of the vulnerability faced by this age group. This collaborative effort aims to create a safer environment by dispelling the stigma surrounding aging and mental health. The model aims to encourage older adults to improve their behavior of seeking help and recognize the significance of mental well-being. The lack of socioecological viewpoints in public health research pertaining to the older population has resulted in mental health and geriatric care policies being created without considering the difficulties faced by older adults in their personal, community, and organizational interactions. Most public healthcare policies for older adults concentrate on addressing neurological and psychological disorders in individuals exhibiting symptoms. However, it is crucial for social workers and public health professionals to address the knowledge gap and societal biases related to mental health needs in the geriatric population, both for those with symptoms and those without symptoms, who are older than 65 years. By emphasizing the significance of interpersonal relationships, organizations, public policies, and the community, this innovative approach to geriatric care will contribute to future discussions in public health, psychology, and social work, focusing on identifying social barriers that hinder help-seeking behavior and access to mental health services for older adults. This shift in behavior within geriatric health disciplines will promote the creation of an inclusive space for the older population in society, free from the stigma and misconceptions associated with seeking mental health care. Practitioners utilizing a comprehensive socioecological model will be guided in addressing the concerns experienced by the older population, empowering them to recognize their essential role within the social fabric. Abbreviations SDoH: social determinants of health; ScEcM: socioecological model Declarations The author did not receive support from any organization for the submitted work. The author declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author has no conflicts of interest to declare that they are relevant to the content of this article. Author Contribution N.M. is the sole author of the entire manuscript and revised it critically for important intellectual content. N.M. agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. References Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC geriatrics , 19 (1), 1-15. https://doi.org/10.1186/s12877-019-1189-9 Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research , 9 (3), 208–220. PMID: 4436074; PMCID: PMC1071804. Alzheimer's Association. (2019, March 01). Alzheimer's disease facts and figures. Alzheimer's & Dementia , 14 (5), 701-718 https://doi.org/10.1016/j.jalz.2018.02.001 Banerjee, D., Rabheru, K., Ivbijaro, G., & de Mendonca Lima, C. A. (2021). Dignity of Older Persons With Mental Health Conditions: Why Should Clinicians Care?. Frontiers in psychiatry , 12 , 774533. https://doi.org/10.3389/fpsyt.2021.774533 Bickerdike, L., Booth, A., Wilson, P. M., Farley, K., & Wright, K.. (2017). Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open , 7 (4), e013384. https://doi.org/10.1136/bmjopen-2016-013384 Black, D., Morris, J. N., Smith, C. and Townsend, P. (1980). Report of the working group on inequalities in Health. London: Stationery Office. Bowling, A., & Gabriel, Z. (2007). Lay theories of quality of life in older age. Ageing and Society , 27 (6), 827–848. https://doi.org/10.1017/s0144686x07006423 Bronfenbrenner, U. (1979). The ecology of human development . Harvard University Press. Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Getting the Word Out: New Approaches for Disseminating Public Health Science. Journal of public health management and practice : JPHMP , 24 (2), 102–111. https://doi.org/10.1097/PHH.0000000000000673 Canvin, K., Macleod, C. A., Windle, G., & Sacker, A. (2018). Seeking assistance in later life: how do older people evaluate their need for assistance?. Age and Ageing , 47 (3), 466–473. https://doi.org/10.1093/ageing/afx189 Centers for Disease Control and Prevention (2006, April). Behavioral Risk Factor Surveillance System. Depression and Anxiety Module. Morbidity and Mortality Weekly Report . 59 (38). 1229-1335. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm?s_cid=mm5938a2_w Chávez, E. M., Calvo, J., & Jones, J. (2016). The Santa Fe group strategy: how Medicare can integrate health and oral care for older Americans. Journal of the American Society on Aging , 40 (3), 94-99. https://doi.org/10.1177/00914150221106098 Chen, J. T., Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Cutler, H., Low, L. F., Georgiou, A., Johnco, C., Jones, M., Meuldijk, D., & Partington, A. (2022). Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial. PloS one , 17 (6), e0269981. https://doi.org/10.1371/journal.pone.0269981 Chen, Y., & Zhao, H. (2023). Long-term care insurance, mental health of the elderly and its spillovers. Frontiers in public health , 11 , 982656. https://doi.org/10.3389/fpubh.2023.982656 Clark, L. A., & Boyd, A. S. (2017). Health disparities and social determinants of health among the elderly. Journal of Cultural Diversity , 24 (4), 118-125. Retrieved from https://utk.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/health-disparities-social-determinants-among/docview/1985538236/se-2 Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM - population health , 15 , 100847. https://doi.org/10.1016/j.ssmph.2021.100847 Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest , 15 (2), 37–70. https://doi.org/10.1177/1529100614531398 Cramer, R. J., & Kapusta, N. D. (2017). A Social-Ecological Framework of Theory, Assessment, and Prevention of Suicide. Frontiers in psychology , 8 , 1756. https://doi.org/10.3389/fpsyg.2017.01756 Das, K. V., Jones-Harrell, C., Fan, Y., Ramaswami, A., Orlove, B., & Botchwey, N.. (2020). Understanding subjective well-being: perspectives from psychology and public health. Public Health Reviews , 41 (1). https://doi.org/10.1186/s40985-020-00142-5 Dombou, C., Omonaiye, O., Fraser, S., Cénat, J. M., Fournier, K., & Yaya, S. (2023). Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review. PloS one , 18 (6), e0287162. https://doi.org/10.1371/journal.pone.0287162 Ebrahimi, H., Hosseinzadeh, M., Seifi Saray, R., Wilson, M., & Namdar Areshtanab, H. (2022). Ability of older adults to recognize cognitive changes and its relationship with mental health: a cross-sectional study. BMC Geriatrics , 22 (1). https://doi.org/10.1186/s12877-022-03096-2 Farriol-Baroni, V., González-García, L., Luque-García, A., Postigo-Zegarra, S., & Pérez-Ruiz, S.. (2021). Influence of Social Support and Subjective Well-Being on the Perceived Overall Health of the Elderly. International Journal of Environmental Research and Public Health , 18 (10), 5438. https://doi.org/10.3390/ijerph18105438 Foong, H. F., Lim, S. Y., Koris, R., & Haron, S. A.. (2021). Time-Use and Mental Health in Older Adults: A Scoping Review. International Journal of Environmental Research and Public Health , 18 (9), 4459. https://doi.org/10.3390/ijerph18094459 Frank, R. G., Beronio, K., & Glied, S. A. (2014). Behavioral health parity and the affordable care act. Journal of Social Work in Disability & Rehabilitation , 13 (1-2), 31–43. https://doi.org/10.1080/1536710x.2013.870512 Frank, R. G., Goldman, H. H., & Mcguire, T. G. (2001). Will parity in coverage result in better mental health care? New England Journal of Medicine , 345 (23), 1701–1704. https://doi.org/10.1056/nejm200112063452311 Fulmer, T., & Chernof, B. (2018). Handbook of Geriatric Assessment. (5th ed.). Jones & Bartlett Learning, LLC. Fulmer, T., Reuben, D. B., Auerbach, J., Fick, D. M., Galambos, C., & Johnson, K. S. (2021). Actualizing Better Health And Health Care For Older Adults: Commentary describes six vital directions to improve the care and quality of life for all older Americans. Health Affairs , 40 (2), 219-225. https://doi.org/10.1377/hlthaff.2020.01470 Gottlieb, L., Fichtenberg, C., Alderwick, H., Adler, N. (2019). Social determinants of health. Journal of Healthcare Management , 64(4) , 243-257 https://doi.org/10.1097/JHM-D-18-00160 Greysen, S. R., Hoi‐Cheung, D., Garcia, V., Kessell, E., Sarkar, U., Goldman, L., Schneidermann, M., Critchfield, J., Pierluissi, E., & Kushel, M.. (2014). “Missing Pieces”—Functional, Social, and Environmental Barriers to Recovery for Vulnerable Older Adults Transitioning from Hospital to Home. Journal of the American Geriatrics Society , 62 (8), 1556–1561. https://doi.org/10.1111/jgs.12928 Hayashi, M. (2013). The care of older people: England and Japan, A Comparative Study. Studies For the Society for The Social History of Medicine , 1 (11). https://doiorg.utk.idm.oclc.org/10.4324/9781315654560 HIPAA Mental Health Parity Act of 1996, 62 FR 66967 (1996). https://www.govinfo.gov/content/pkg/FR-1997-12-22/pdf/FR-1997-12-22.pdf Holt-Lunstad, J., Robles, T. F., & Sbarra, D. A.. (2017). Advancing social connection as a public health priority in the United States.. American Psychologist , 72 (6), 517–530. https://doi.org/10.1037/amp0000103 Hsu, H. C., Liang, J., Luh, D. L., Chen, C. F., & Wang, Y. W. (2019). Social Determinants and Disparities in Active Aging Among Older Taiwanese. International Journal of Environmental Research and Public Health , 16 (16), 3005. https://doi.org/10.3390/ijerph16163005 Irwin, A., & Scali, E. (2007). Action on the social determinants of health: A historical perspective. Global Public Health , 2 (3), 235–256. https://doi.org/10.1080/17441690601106304 Joo, J. H., Jimenez, D. E., Xu, J., & Park, M. (2019). Perspectives on Training Needs for Geriatric Mental Health Providers: Preparing to Serve a Diverse Older Adult Population. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry , 27 (7), 728–736. https://doi.org/10.1016/j.jagp.2019.03.015 Kemperman, A., Van Den Berg, P., Weijs-Perrée, M., & Uijtdewillegen, K. (2019). Loneliness of Older Adults: Social Network and the Living Environment. International Journal of Environmental Research and Public Health , 16 (3), 406. https://doi.org/10.3390/ijerph16030406 Khazanov, G. K., Morris, P. E., Beed, A., Jager-Hyman, S., Myhre, K., McKay, J. R., Feinn, R. S., Boland, E. M., & Thase, M. E. (2022). Do financial incentives increase mental health treatment engagement? A meta-analysis. Journal of consulting and clinical psychology , 90 (6), 528–544. https://doi.org/10.1037/ccp0000737 Koma, W., Cubanski, J., Neuman, T. (2021, June 4). A snapshot of sources of coverage among Medicare beneficiaries in 2018 . Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries-in-2018/ Korlagunta, K. (2011). Utilization of the socio-ecological model to evaluate older Oklahomans' abilty to grocery shop, prepare food and eat. Oklahoma State University. 12-45. Retrieved Oct 02, 2021 from https://shareok.org/bitstream/handle/11244/6863/Department%20of%20Nutritional%20Sciences_12.pdf;jsessionid=E722618C8E3426FF4017349D91CFE2CB?sequence=1 Kumar, R. (2013, August 15). Social determinants of health among elderly: an anthropological study (Publication No. ISSN 2321–9548). International Journal of Research in Sociology and Social Anthropology , 1 (1), 11-16. Loo, B. P., Mahendran, R., Katagiri, K., & Lam, W. W. (2017). Walking, neighbourhood environment and quality of life among older people. Current opinion in environmental sustainability , 25 , 8-13. https://doi.org/10.1016/j.cosust.2017.02.005 Lund, J. J., Chen, T. T., LaBazzo, G. E., Hawes, S. E., & Mooney, S. J. (2021). The association between three key social determinants of health and life dissatisfaction: A 2017 behavioral risk factor surveillance system analysis. Preventive medicine , 153 , 106724. https://doi.org/10.1016/j.ypmed.2021.106724 Newell, K. W. (Ed.). (1975). Health by the people. Swiss Francs Social Work. https://doi.org/10.1093/sw/21.3.256-a Older Americans Act of 1965, 42 U.S.C. ch. 35 § 3001 et seq. (1965). https://www.govinfo.gov/app/details/CREC-1996-09-06/CREC-1996-09-06-pt1-PgS10024-3 Pavon, J. M., Fish, L. J., Colón‐Emeric, C. S., Hall, K. S., Morey, M. C., Pastva, A. M., & Hastings, S. N. (2021). Towards “mobility is medicine”: socioecological factors and hospital mobility in older adults. Journal of the American Geriatrics Society , 69 (7), 1846-1855. https://doi.org/10.1111/jgs.17109 Perez, F. P., Perez, C. A., & Chumbiauca, M. N. (2022). Insights into the Social Determinants of Health in Older Adults. Journal of biomedical science and engineering , 15 (11), 261–268. https://doi.org/10.4236/jbise.2022.1511023 Perez, F. P., Perez, C. A., & Chumbiauca, M. N. (2022). Insights into the Social Determinants of Health in Older Adults. Journal of biomedical science and engineering , 15 (11), 261–268. https://doi.org/10.4236/jbise.2022.1511023 Piolatto, M., Bianchi, F., Rota, M., Marengoni, A., Akbaritabar, A., & Squazzoni, F.. (2022). The effect of social relationships on cognitive decline in older adults: an updated systematic review and meta-analysis of longitudinal cohort studies. BMC Public Health , 22 (1). https://doi.org/10.1186/s12889-022-12567-5 Poey, J. L., Burr, J. A., & Roberts, J. S.. (2017). Social Connectedness, Perceived Isolation, and Dementia: Does the Social Environment Moderate the Relationship Between Genetic Risk and Cognitive Well-Being?. The Gerontologist , 57 (6), 1031–1040. https://doi.org/10.1093/geront/gnw154 Pooler, J., & Srinivasan, M. (2018, May). Social determinants of health and the aging population. Issue Brief. IMPAQ International . Retrieved Oct 06, 2021 from https://impaqint.com/sites/default/files/files/Issue%20Brief_SDOHHandAgingPopulation.pdf Reynolds, C. F., 3rd, Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022). Mental health care for older adults: recent advances and new directions in clinical practice and research. World psychiatry : official journal of the World Psychiatric Association (WPA) , 21 (3), 336–363. https://doi.org/10.1002/wps.20996 Rook, K. S., & Charles, S. T. (2017). Close social ties and health in later life: Strengths and vulnerabilities. The American psychologist , 72 (6), 567–577. https://doi.org/10.1037/amp0000104 Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American psychologist , 73 (4), 433–450. https://doi.org/10.1037/amp0000298 Rowan, K., McAlpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care, by insurance status, 1999-2010. Health affairs (Project Hope) , 32 (10), 1723–1730. https://doi.org/10.1377/hlthaff.2013.0133 Saarloos, D., Kim, J. E., & Timmermans, H. (2009). The Built Environment and Health: Introducing Individual Space-Time Behavior. International Journal of Environmental Research and Public Health , 6 (6), 1724–1743. https://doi.org/10.3390/ijerph6061724 Sivakumar, P. T., Mukku, S. S. R., Kar, N., Manjunatha, N., Phutane, V. H., Sinha, P., Kumar, C. N., & Math, S. B. (2020). Geriatric telepsychiatry: promoting access to geriatric mental health care beyond the physical barriers. Indian Journal of Psychological Medicine , 42 (5), 41S–46S. https://doi.org/10.1177/0253717620958380 Stuart, H. (2016). Reducing the stigma of mental illness. Global mental health (Cambridge, England) , 3 , e17. https://doi.org/10.1017/gmh.2016.11 Subu, M. A., Wati, D. F., Netrida, N., Priscilla, V., Dias, J. M., Abraham, M. S., Slewa-Younan, S., & Al-Yateem, N.. (2021). Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. International Journal of Mental Health Systems , 15 (1). https://doi.org/10.1186/s13033-021-00502-x Teo, K., Churchill, R., Riadi, I., Kervin, L., Wister, A. V., & Cosco, T. D. (2022). Help-Seeking Behaviors Among Older Adults: A Scoping Review. Journal of Applied Gerontology , 41 (5), 1500-1510. https://doi.org/10.1177/07334648211067710 Tur-Sinai, A. (2022). Out-of-Pocket Expenditure on Medical Services Among Older Adults: A Longitudinal Analysis. Frontiers in public health , 10 , 836675. https://doi.org/10.3389/fpubh.2022.836675 Wallace, P. M., & Sterns, H. L. (2022). Considerations of Family Functioning and Clinical Interventions. Gerontology & geriatric medicine , 8 , 23337214221119054. https://doi.org/10.1177/23337214221119054 West, K.H., Milne, A., Hotham, S. (2020). New horizons in supporting older people’s health and wellbeing: is social prescribing a way forward? Age and Aging , 49 , 319-326. https://doi.org/10.1093/ageing/afaa016 Wickramaratne, P. J., Yangchen, T., Lepow, L., Patra, B. G., Glicksburg, B., Talati, A., Adekkanattu, P., Ryu, E., Biernacka, J. M., Charney, A., Mann, J. J., Pathak, J., Olfson, M., & Weissman, M. M.. (2022). Social connectedness as a determinant of mental health: A scoping review. PLOS ONE , 17 (10), e0275004. https://doi.org/10.1371/journal.pone.0275004 Woods, M. D., Kirk, D., Agarwal, S., Annandale, E., Arthur, T., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L., Riley, R., Sutton, A. (2005, April). Vulnerable groups and access to health care: A critical interpretive review. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D , 34-68. World Health Organization. (2023, March 15). Dementia . World Health Organization Newsroom - Dementia. Retrieved (December 15, 2023), from https://www.who.int/news-room/fact-sheets/detail/dementia#:~:text=Key%20facts,injuries%20that%20affect%20the%20brain. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4360005","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Perspective","associatedPublications":[],"authors":[{"id":300382352,"identity":"cdbb9888-761d-4722-9533-e7e89c693f22","order_by":0,"name":"Namrata Mukherjee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYHACZmYgwcPPwMB4AMSVgGKCWmQkGxgYQFokiNZiY3CAWC3mYmeMjQsq7vEY30g+cPAHw+E6yQbmg7d58GixnJ1jnDzjTDGP2Y20hMM8DIclpBnYkq3xaTG4nWN8mLctgcfszBmDwwxALXIMPGbShLX8S+Ax7jljAHIYUAv/N4JaknkbEngM2HsMDkAcxsNGQEtasTHPsQQeieNtQL8YpEvObGYztpyDV0vyZmmemgR7/mbmgw9/VFjzSxxvfnjjDR4t6CYAMTPxykfBKBgFo2AU4AAAlcxDIMzioRgAAAAASUVORK5CYII=","orcid":"","institution":"University of Tennessee at Knoxville","correspondingAuthor":true,"prefix":"","firstName":"Namrata","middleName":"","lastName":"Mukherjee","suffix":""}],"badges":[],"createdAt":"2024-05-02 15:29:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4360005/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4360005/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56282942,"identity":"7a390bcf-9230-41ad-9484-7478174754df","added_by":"auto","created_at":"2024-05-10 21:37:18","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":616448,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSocioecological Model for Mental Health Accessibility in Geriatric Care\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4360005/v1/1739371d8256bd66eff5d2c2.jpeg"},{"id":62394941,"identity":"cc7e6bcb-9a87-4ece-9c46-29b221231111","added_by":"auto","created_at":"2024-08-13 16:50:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1045106,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4360005/v1/9508e529-7b49-4d4f-9120-d1273175aefa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving Aging Mental Health Services in Developing Economies: A Socio-Ecological Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOld age-specific care focusing on compromised cognition is essential for the overall well-being of people aged 65 years and older. Specialized care in old age can enable them to maintain their health and autonomy for a longer period. Additionally, the process of aging is often accompanied by a range of health and cognitive issues (Abdi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It is estimated that 5.8\u0026nbsp;million Americans have progressive cognition disease and that Alzheimer's disease and related dementias (ADRD) affect more than 55\u0026nbsp;million individuals globally, with a majority exceeding 60% residing in low- and middle-income nations. (WHO, 2023). Among older adults, approximately 10\u0026ndash;15% suffer from symptomatic cognitive dysfunction, such as dementia, and an additional 5\u0026ndash;10% have nonclinical symptoms. Approximately 90% of the older population who experience clinical and nonclinical symptoms does not receive the necessary treatment (Sivakumar et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The prevailing knowledge gap regarding the inaccessibility of adequate mental health services for older adults experiencing cognitive decline is because a considerable amount of related research neglects the interplay of social, ecological, and policy factors that impact the older population's ability to pursue mental health care (Greysen et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This has adverse consequences for physical health, life expectancy, quality of life, family, relationships, and finances, with significant public health implications (Ebrahimi et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproaching mental health for the aging population should be focused beyond the layers of clinical detection and treatment of symptoms to acknowledge the role of social aspects in mental well-being. Case managers should use a multidisciplinary care plan that looks at controlling social and structural factors influencing access to mental health for older adults (Rosen et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The barriers to accessing mental health services for older adults can be understood by applying the social determinants of health (SDoH) framework, whose impact varies for each person. Structural and functional changes in social determinants of health for older adults, such as economic stability, relationships within the neighborhood and environment, healthcare access, availability of services, and perceptions of role in society, contribute significantly to their knowledge and help-seeking behavior (Pooler \u0026amp; Srinivasan, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These social determinants impact the ability of the aging population to comprehend the benefits of mental health services and seek out care. Aging care plans informed by appropriately designed models that take social deterrents and ecological perspectives into account are needed to improve our mental health as we age (Joo et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The purpose of this review paper is to formulate a macrolevel approach to geriatric care aimed at addressing the research question of how a socioecological model (ScEcM) can influence the accessibility of mental well-being services for older adults in less developed economies. This model aligns with socioecological theory, which outlines five main players\u0026mdash;individual, interpersonal, organizational, community, and public policy\u0026mdash;that influence human behavior (Bronfenbrenner,1979). The significance of this model for developing countries is to strengthen the ecology surrounding the individual and help in the assessment, monitoring, evaluation, and mitigation of the barriers to aging social determinants of health, thereby helping individuals develop better help-seeking behavior in a society that is free of stigma.\u003c/p\u003e \u003cp\u003eTo date, there has been insufficient research dedicated to mental health care for older individuals, considering the social barriers arising from the interplay of socioecological theory components. Although many studies have identified social challenges influencing healthcare access that emerge with aging, limited evidence can be found in the literature on how to reduce these challenges by engaging in partnerships at the macrolevel to develop better behavior related to seeking proper mental health care (Foong et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Considering that mental health is vital to the quality of life of older adults, a socioecological model involving multiple stakeholders offers a solution to the microlevel detection of social deterrents that cause psychological distress (Cramer \u0026amp; Kapusta, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This approach will enable social workers to discern older adults who do not have clinical symptoms of mental disorders but who face barriers in their social interactions. With weak social interactions and cognitive abilities among the older population, it is important to build on the lack of research conceptualizing a ScEcM so that mental health care can receive priority at multiple levels in society in order to round out geriatric care (Piolatto et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe purpose of this literature review was to determine how best to adapt socioecological theory to address social determinants of health. The literature review helped us to comprehend the extent of the impact of social determinants of health on mental health during our aging process. Subsequently, the proposed model utilizes the components of socioecological theory to influence the accessibility of mental health services. To design the socioecological model (ScEcM), a literature search was performed using the following set of terms: ( \"geriatric\" OR \"elder\" OR \"senior citizens\" OR gerontol*) AND (\"mental wellbeing\" OR \"psychological wellbeing\" OR \"emotional wellbeing\" OR \"wellbeing\" OR \" mental health\") AND (\"[social determinants of health\" OR \"economic stability\" OR \"education access\" OR \"education quality\" OR \"quality of education\" OR \"healthcare access\" OR \"healthcare quality\" OR \"quality of healthcare\" OR \"neighborhood environment\" OR \"built environment\" OR \"social context\" OR \"community context\" OR \"help seeking behavior\" OR \"public policy\") AND (\"access to care\" OR \"access to healthcare\" OR \"access to services\" OR \"accessibility\" OR access*)). The seven databases that were used were PUBMED, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, APA PsycINFO, the Web of Science, Social Work Abstracts, the Academic Search Complete, and SCOPUS. These search terms were carefully designed to encompass elements of socioecological theory when viewed through social determinants of the health framework. The literature review aimed to comprehend accessibility and its influencing factors by examining practices in countries with robust healthcare systems. The goal was to devise a model that aids practitioners in organizing aging care in nations with limited access to mental health and geriatric well-being services.\u003c/p\u003e\n\u003cp\u003eDue to the lack of concentrated research focused on socioecological perspectives influencing social determinants of health, it was necessary to include both quantitative and qualitative studies to be able to capture a majority of unique discussions on this topic. The inclusion of articles specific to the USA and Europe was focused on because of the robustness of these healthcare structures. The population in the study was kept open to the 65\u0026thinsp;+\u0026thinsp;year age bracket because the components of social relationships have been found to influence the mental health of the geriatric population right from their retirement stage, and this influence progresses with age (Wickramaratne et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). It was important to maintain the focus of the study on social and ecological aspects associated with healthy aging and exclude studies that dealt with mental health screening and treatment in depth from a medical perspective. The literature search provided substantial evidence to support the claim that there is a lack of literature dealing with the socioecological aspects of older adults that can influence their mental health accessibility. Most of the related studies have shown the social determinants of health framework to be critical for understanding the accessibility of mental health; however, most have failed to connect these factors to socioecological factors that influence human behavior. The intersection of aging care, the challenges faced by older adults with their experiences with policies, social support, community interactions, and patterns of help-seeking behavior is a fresh topic for understanding this problem.\u003c/p\u003e"},{"header":"Combining Social Determinants of Health Frameworks with Socioecological Theory","content":"\u003cp\u003eThe scope of the conceptual paper enabled us to explore a well-analyzed and frequently used framework of social determinants of health in geriatric research and gerontology. Since March 2005, the social determinants of health (SDoH) framework has been used to understand the problems associated with health access and assemble scientific evidence to change policy and practices related to healthcare management (Irwin \u0026amp; Scali, \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e). Newell (\u003cspan class=\"CitationRef\"\u003e1975\u003c/span\u003e) explained the importance of robust engagement with the social dimensions of health that allowed us to understand the causes of health problems emerging within society. Any approach related to access to healthcare services from a strict health sectoral approach will be ineffective because the causes lie within society and outside the fields of healthcare systems (Newell, \u003cspan class=\"CitationRef\"\u003e1975\u003c/span\u003e). This also holds true in the case of mental health accessibility in geriatric care. With the diminished cognitive abilities and difficulties faced by older adults in interactions with the social determinants of health, effective geriatric care management can be achieved only by tackling the social challenges that hinder access. With increasing age at retirement, the ability to pay for healthcare services gradually declines for older adults. The loss of cognitive abilities and perceptions of losing value within society impact individuals\u0026rsquo; ability to strengthen social connectedness (Poey et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). The SDoH framework is especially crucial for crafting a model that concentrates on pinpointing societal issues deeply linked to impeding access to mental health in the management of geriatric care. Black and colleagues (\u003cspan class=\"CitationRef\"\u003e1980\u003c/span\u003e) discussed in a report that addressing health disparities linked to access necessitates social policy interventions concentrating on healthcare service delivery. This involves identifying social issues and discrimination that directly impede certain individuals' access to appropriate healthcare facilities. A multistakeholder model that uses community-level strategies through a mix of direct investments in communities and collaboration through multisector partnerships (Gottlieb et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e) can improve the conditions of social determinants associated with healthcare access. Elements such as social connections, the presence of healthcare services, well-designed public policies, community engagement, and income fairness should be considered when formulating any model to address challenges related to accessing mental health services (Holt-Lunstad et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe neoliberal health sector reforms (HSR) of the 1980s and 1990s aimed to address structural problems in health systems and poor systems management by proposing to take into account the impact of social determinants in designing sustainable frameworks and models that understand healthcare inaccessibility from the nuances of the role of a strong social structure (Irwin \u0026amp; Scali, \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e). This strongly confirms the necessity of adapting the SDoH framework to investigate health and well-being issues in geriatric care. The findings also underscore the importance of designing models that target interventions targeting the social and ecological factors that hinder access to mental health.\u003c/p\u003e\n\u003cp\u003eSocioecological theory should be developed where several social factors need to be identified as potentially modifiable targets for intervention (Pavon et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). The socioecological model (ScEcM) is adapted from the socioecological theory of human behavior (Bronfenbrenner, \u003cspan class=\"CitationRef\"\u003e1979\u003c/span\u003e), which helps in the assessment, monitoring, evaluation, and mitigation of the barriers to social determinants of health. The SDoH acts as a key mediator among the various elements individuals engage within society when constructing any model intended to tackle healthcare access challenges. Utilizing the SDoH framework to establish a ScEcM is beneficial for examining literature evidence that underscores the significance of intrapersonal relationships for older adults and how this reliance influences their access to a high quality of life.\u003c/p\u003e"},{"header":"Evidence of the Problem","content":"\u003cp\u003eMental 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 \u0026ldquo;rarely\u0026rdquo; or \u0026ldquo;never\u0026rdquo; received the social and emotional support they needed than adults aged 50\u0026ndash;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., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e), 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.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eSocial determinants of health and accessibility\u003c/h2\u003e\n \u003cp\u003eThe 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.\u003c/p\u003e\n \u003cp\u003eThese 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\u0026rsquo;s role in society (Perez et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Individuals who struggle with SDoH-related factors are at risk of experiencing poor health, morbidity, and mortality (Lund et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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 \u0026amp; Srinivasan, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). 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 \u0026amp; Chernof, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). 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, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). This social stratification emerges from the various social determinants of health that affect an individual\u0026rsquo;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, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e); 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 \u0026ldquo;burden\u0026rdquo; 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\u0026mdash;such as stable employment and income, a secure environment, accessible and affordable healthcare services, and active societal participation\u0026mdash;can be addressed through interpersonal and intrapersonal interactions experienced by individuals over the course of their life.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eSocioecological Factors in Context to Geriatric Care and Mental Health\u003c/h2\u003e\n \u003cp\u003eAny 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., \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e). 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 (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) 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\u0026rsquo; 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., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). 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 (\u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e) 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., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). A larger social network among older adults within the community is associated with a greater probability of receiving better treatment (Kemperman et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Hayashi (\u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e) 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\u0026rsquo; ability to interact with social determinants (Fitzgerald, 2009 as cited in Korlagunta, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e), 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.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eAccess versus Help-Seeking Behavior\u003c/h2\u003e\n \u003cp\u003eThe 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 \u0026amp; Moen, 2002, as cited in Clark \u0026amp; Boyd, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2005\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). 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\u0026rsquo;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 \u0026amp; 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., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e), 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.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eParity of Public Policy in Geriatric Mental Care\u003c/h2\u003e\n \u003cp\u003eHealthcare 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 \u0026amp; Boyd, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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 (Ch\u0026aacute;vez et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Ch\u0026aacute;vez and colleagues (\u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e) 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 \u0026amp; Neuman, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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 \u0026amp; Chernof, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). 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, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e) 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., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e). 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., \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e). 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.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Development of a Socioecological Model","content":"\u003cp\u003eAging is a gradual process, but the aim of aging interventions should be focused on supporting older adults by involving multiple sectors to address social determinants. Basic mental care services can be provided to older adults through the coalescence of public policy mechanisms and complex social and intrapersonal relationships within the ecosystem. This can be achieved by advancing the challenges of accessing mental health through the use of a macrolevel socioecological intervention mechanism. The model is designed keeping in mind the viability of on-ground implementation by practitioners in nations with poor access to mental health for the geriatric population and engaging multiple players who are responsible for the social determinants of health. This model can be used for handling multiple deterrents together along with replicating it for a geriatric population of lower- and middle-income groups to encourage access to mental health. The five intervention levels of this socioecological model are identifying, encouraging, integrating, enrolling, and incentivizing. Each of these five levels has a unique ability to encompass the players of socioecological theory in tackling social determinants of health. The following paragraphs outline the various ways in which the model can be applied to provide better mental health outcomes for older adults. The visualization of the model is provided below (see Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n\u003ch2\u003eIdentify\u003c/h2\u003e\n\u003cp\u003eIt is essential to identify the challenges faced by older adults in multidimensional interactions within the social determinants of health. The family, community, health practitioner, and organization to which older adults belong should acknowledge the challenges and focus on fast and streamlined identification of social considerations. Recent studies have revealed older adults' access to mental health services through individual-centric support systems within their familial and social circles (Perez et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). This will enable older adults to garner confidence and minimize inequality of life opportunities such as mental health care, which is associated with social stratification. The identification process should be focused on encouraging recounts of personal challenges, whether that includes struggling with the ability to pay, building social connections, etc. (Chen et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). The concept of social prescribing has been found to yield positive results in promoting better accessibility (Bickerdike et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). This mode of delivery for identification of social determinants of health should be at the community level to channel sensitization about the social stratification and eradicate stigma associated with mental health care.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eEncourage\u003c/h2\u003e\n\u003cp\u003eAs identified from the literature, there is a lack of acceptance of support by many older adults that is available through health care providers. The main reason for this absence of help-seeking behavior can be attributed to the fear of shunning from one\u0026rsquo;s family, friends, and other interpersonal relationships that people assume will be associated with mental illness (Subu et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). It is very important to focus on the issue of mental well-being and physical well-being for people older than 65 years of age by encouraging dialogs within the family. Human behavior is heavily influenced by the systems around an individual, and the behavior of older adults actively seeking help can be enhanced when they can find support from the social relationships that an older person has as they age (Rook \u0026amp; Charles, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). The family is usually the primary caregiver, and any ScEcM member should anchor upon family support to ensure that the geriatric population approaches quality mental health care (Wallace \u0026amp; Sterns, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). These dialogs can be better channeled in the presence of a geriatric care manager who can explain the importance of mental well-being in collective quality of life (Reynolds et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). The acceptance of the issue within the primary circle of the aging individual will garner an increased level of confidence and better support systems for the individual.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eIntegrate\u003c/h2\u003e\n\u003cp\u003eStructured policies that are focused on the concept of parity among all strata of the older population should be designed. Due to the high out-of-pocket expense of accessing mental healthcare for people in low- and middle-income groups, conditional coverage in health insurance and economic burdens contribute to most of the older population not seeking mental healthcare (Rowan et al., \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e). This results in a higher detection rate and treatment of psychological disorders among the population with the ability to pay, creating inequity within the geriatric population. To tackle the stigma around mental health in developing economies, it is imperative to design initiatives that forge partnerships with policy and healthcare systems to address socioeconomic inequity (Stuart, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Practitioners must provide the impetus to policymakers to structure strong policies that are inclusive and acknowledge economic segregation to make mental health accessible to all sections of the older population (Tur-Sinai, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). The integration of parity should be prioritized when designing healthcare policies for older adults.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eEnroll\u003c/h2\u003e\n\u003cp\u003ePublic policy can be considered the major contributing variable in making structured healthcare accessible for the older population. However, the process of enrollment can be challenging for some people because of their educational or economic background. It is important to integrate the enrollment process into structured policies in an easy and efficient manner (Reynolds et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). The role of the practitioner will be to enable effective communication of available schemes and connect them to healthcare opportunities. In developing economies, mental health inaccessibility among older adults emerges from barriers to knowledge and the lack of outreach resources about mental health policies (Dombou et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). Proper guidance throughout the enrollment process, multiple channels of dissemination of information, and effective dialogs will warrant better outreach and coverage (Brownson et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). With coherent and comprehensive enrollment and coverage of public health schemes, older adults seeking mental health support in developing economies are expected to experience higher incidences (Chen \u0026amp; Zhao, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). Media and advertisement agencies are among the media that practitioners can use for the implementation of this intervention.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eIncentivize\u003c/h2\u003e\n\u003cp\u003eThe literature review suggests that many of the organizational healthcare schemes do not cover mental healthcare adequately or completely ignore it. Changes in the organizational operating structure cannot be enforced through aging policies. The lack of identification of inaccessibility to mental healthcare among the older population is an area of concern (Coombs et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). The role of the practitioner will be to propagate the change in outlook through society-level acknowledgment of the importance of mental well-being for older adults (Banerjee et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). A recent meta-analysis revealed that greater outcomes of seeking mental health services are associated with greater organizational insurance coverage and greater organizational commitment to improving the health outcomes of employees (Khazanov et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). By recognizing the contributions of older adults to the organizations they are associated with, practitioners can strategize with organizations to design health benefits that cover mental health care. Organizations or the work environment of older adults can come to the forefront of making mental health accessible and affordable by offering stable medical aid and concentrating on retirement benefits that cover mental protection care (Reynolds et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). This behavioral change within the system is proposed to be inculcated through a reward mechanism to organizations that provide better retirement health plans and insurance plans that cover mental health care for the aging population.\u003c/p\u003e\n\u003cp\u003eThis five-step socioecological model will enable practitioners to propagate policy-level acknowledgment of the social challenges associated with aging. Social work and public health practitioners should try to incorporate the model on cross-sectoral engagement levels involving family and friends, policy think tanks, organizations that older adults were/are associated with and the community at large. Each intervention is independent of the other but mediates the recognition of the elements of socioecological theory. All of these interventions can work together to address the challenges of social determinants of health in older adults, develop better help-seeking behavior, and understand the importance of mental well-being.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eFuture Scope\u003c/h3\u003e\n\u003cp\u003eThe ScEcM is proposed to be the beginning of approaching geriatric care by maintaining a focus on social and ecological aspects associated with aging. There is a need for concrete evidence-based research on social action, and this propels the scope for undertaking future research from the focal point of educational status, geography, income and standard of living, belief systems, and gender. The study briefly addresses the importance of introducing parity in healthcare services and public policies for all economic strata. The impact of income on accessibility can be explored further to determine the effectiveness of this model. The ScEcM can be interpreted as an introductory model to make mental healthcare accessible to the geriatric population. It also does not explore the execution of the model in urban versus rural settings of population demography. The effectiveness of the model across all demographic factors can be explored in subsequent research. Future research may also focus on understanding the specifics of the lack of accessibility to different groups within this age bracket.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThere is an urgent need to comprehend the social intricacies linked to the aging process and its impact on mental health access. The socioecological model is tailored for professionals who have gained an understanding of the barriers that hinder accessibility. Its purpose is to bring together various interventions aimed at engaging multiple stakeholders to maximize participation. By involving different individuals and promoting social prescribing, society can become more aware of the vulnerability faced by this age group. This collaborative effort aims to create a safer environment by dispelling the stigma surrounding aging and mental health. The model aims to encourage older adults to improve their behavior of seeking help and recognize the significance of mental well-being. The lack of socioecological viewpoints in public health research pertaining to the older population has resulted in mental health and geriatric care policies being created without considering the difficulties faced by older adults in their personal, community, and organizational interactions. Most public healthcare policies for older adults concentrate on addressing neurological and psychological disorders in individuals exhibiting symptoms. However, it is crucial for social workers and public health professionals to address the knowledge gap and societal biases related to mental health needs in the geriatric population, both for those with symptoms and those without symptoms, who are older than 65 years.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eBy emphasizing the significance of interpersonal relationships, organizations, public policies, and the community, this innovative approach to geriatric care will contribute to future discussions in public health, psychology, and social work, focusing on identifying social barriers that hinder help-seeking behavior and access to mental health services for older adults. This shift in behavior within geriatric health disciplines will promote the creation of an inclusive space for the older population in society, free from the stigma and misconceptions associated with seeking mental health care. Practitioners utilizing a comprehensive socioecological model will be guided in addressing the concerns experienced by the older population, empowering them to recognize their essential role within the social fabric.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSDoH: social determinants of health; ScEcM: socioecological model\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe author did not receive support from any organization for the submitted work. The author declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author has no conflicts of interest to declare that they are relevant to the content of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.M. is the sole author of the entire manuscript and revised it critically for important intellectual content. N.M. agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdi, S., Spann, A., Borilovic, J., de Witte, L., \u0026amp; Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). \u003cem\u003eBMC geriatrics\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 1-15. https://doi.org/10.1186/s12877-019-1189-9\u003c/li\u003e\n\u003cli\u003eAday, L. A., \u0026amp; Andersen, R. (1974). A framework for the study of access to medical care. \u003cem\u003eHealth Services Research\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(3), 208\u0026ndash;220. PMID: 4436074; PMCID: PMC1071804.\u003c/li\u003e\n\u003cli\u003eAlzheimer\u0026apos;s Association. (2019, March 01). Alzheimer\u0026apos;s disease facts and figures. \u003cem\u003eAlzheimer\u0026apos;s \u0026amp; Dementia\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(5), 701-718 https://doi.org/10.1016/j.jalz.2018.02.001\u003c/li\u003e\n\u003cli\u003eBanerjee, D., Rabheru, K., Ivbijaro, G., \u0026amp; de Mendonca Lima, C. A. (2021). Dignity of Older Persons With Mental Health Conditions: Why Should Clinicians Care?. \u003cem\u003eFrontiers in psychiatry\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 774533. https://doi.org/10.3389/fpsyt.2021.774533\u003c/li\u003e\n\u003cli\u003eBickerdike, L., Booth, A., Wilson, P. M., Farley, K., \u0026amp; Wright, K.. (2017). Social prescribing: less rhetoric and more reality. A systematic review of the evidence. \u003cem\u003eBMJ Open\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(4), e013384. https://doi.org/10.1136/bmjopen-2016-013384\u003c/li\u003e\n\u003cli\u003eBlack, D., Morris, J. N., Smith, C. and Townsend, P. (1980). Report of the working group on inequalities in Health. London: Stationery Office.\u003c/li\u003e\n\u003cli\u003eBowling, A., \u0026amp; Gabriel, Z. (2007). Lay theories of quality of life in older age. \u003cem\u003eAgeing and Society\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(6), 827\u0026ndash;848. https://doi.org/10.1017/s0144686x07006423\u003c/li\u003e\n\u003cli\u003eBronfenbrenner, U. (1979). \u003cem\u003eThe ecology of human development\u003c/em\u003e. Harvard University Press.\u003c/li\u003e\n\u003cli\u003eBrownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., \u0026amp; Tabak, R. G. (2018). Getting the Word Out: New Approaches for Disseminating Public Health Science. \u003cem\u003eJournal of public health management and practice : JPHMP\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(2), 102\u0026ndash;111. https://doi.org/10.1097/PHH.0000000000000673\u003c/li\u003e\n\u003cli\u003eCanvin, K., Macleod, C. A., Windle, G., \u0026amp; Sacker, A. (2018). Seeking assistance in later life: how do older people evaluate their need for assistance?. \u003cem\u003eAge and Ageing\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(3), 466\u0026ndash;473. https://doi.org/10.1093/ageing/afx189\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention (2006, April). Behavioral Risk Factor Surveillance System. Depression and Anxiety Module. \u003cem\u003eMorbidity and Mortality Weekly Report\u003c/em\u003e. \u003cem\u003e59\u003c/em\u003e(38). 1229-1335. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm?s_cid=mm5938a2_w\u003c/li\u003e\n\u003cli\u003eCh\u0026aacute;vez, E. M., Calvo, J., \u0026amp; Jones, J. (2016). The Santa Fe group strategy: how Medicare can integrate health and oral care for older Americans. \u003cem\u003eJournal of the American Society on Aging\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(3), 94-99. https://doi.org/10.1177/00914150221106098\u003c/li\u003e\n\u003cli\u003eChen, J. T., Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Cutler, H., Low, L. F., Georgiou, A., Johnco, C., Jones, M., Meuldijk, D., \u0026amp; Partington, A. (2022). Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(6), e0269981. https://doi.org/10.1371/journal.pone.0269981\u003c/li\u003e\n\u003cli\u003eChen, Y., \u0026amp; Zhao, H. (2023). Long-term care insurance, mental health of the elderly and its spillovers. \u003cem\u003eFrontiers in public health\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 982656. https://doi.org/10.3389/fpubh.2023.982656\u003c/li\u003e\n\u003cli\u003eClark, L. A., \u0026amp; Boyd, A. S. (2017). Health disparities and social determinants of health among the elderly.\u003cem\u003e Journal of Cultural Diversity\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(4), 118-125. Retrieved from https://utk.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/health-disparities-social-determinants-among/docview/1985538236/se-2\u003c/li\u003e\n\u003cli\u003eCoombs, N. C., Meriwether, W. E., Caringi, J., \u0026amp; Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. \u003cem\u003eSSM - population health\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e, 100847. https://doi.org/10.1016/j.ssmph.2021.100847\u003c/li\u003e\n\u003cli\u003eCorrigan, P. W., Druss, B. G., \u0026amp; Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. \u003cem\u003ePsychological Science in the Public Interest\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(2), 37\u0026ndash;70. https://doi.org/10.1177/1529100614531398\u003c/li\u003e\n\u003cli\u003eCramer, R. J., \u0026amp; Kapusta, N. D. (2017). A Social-Ecological Framework of Theory, Assessment, and Prevention of Suicide. \u003cem\u003eFrontiers in psychology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e, 1756. https://doi.org/10.3389/fpsyg.2017.01756\u003c/li\u003e\n\u003cli\u003eDas, K. V., Jones-Harrell, C., Fan, Y., Ramaswami, A., Orlove, B., \u0026amp; Botchwey, N.. (2020). Understanding subjective well-being: perspectives from psychology and public health. \u003cem\u003ePublic Health Reviews\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(1). https://doi.org/10.1186/s40985-020-00142-5\u003c/li\u003e\n\u003cli\u003eDombou, C., Omonaiye, O., Fraser, S., C\u0026eacute;nat, J. M., Fournier, K., \u0026amp; Yaya, S. (2023). Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(6), e0287162. https://doi.org/10.1371/journal.pone.0287162\u003c/li\u003e\n\u003cli\u003eEbrahimi, H., Hosseinzadeh, M., Seifi Saray, R., Wilson, M., \u0026amp; Namdar Areshtanab, H. (2022). Ability of older adults to recognize cognitive changes and its relationship with mental health: a cross-sectional study. \u003cem\u003eBMC Geriatrics\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1). https://doi.org/10.1186/s12877-022-03096-2\u003c/li\u003e\n\u003cli\u003eFarriol-Baroni, V., Gonz\u0026aacute;lez-Garc\u0026iacute;a, L., Luque-Garc\u0026iacute;a, A., Postigo-Zegarra, S., \u0026amp; P\u0026eacute;rez-Ruiz, S.. (2021). Influence of Social Support and Subjective Well-Being on the Perceived Overall Health of the Elderly. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(10), 5438. https://doi.org/10.3390/ijerph18105438\u003c/li\u003e\n\u003cli\u003eFoong, H. F., Lim, S. Y., Koris, R., \u0026amp; Haron, S. A.. (2021). Time-Use and Mental Health in Older Adults: A Scoping Review. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(9), 4459. https://doi.org/10.3390/ijerph18094459\u003c/li\u003e\n\u003cli\u003eFrank, R. G., Beronio, K., \u0026amp; Glied, S. A. (2014). Behavioral health parity and the affordable care act. \u003cem\u003eJournal of Social Work in Disability \u0026amp; Rehabilitation\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1-2), 31\u0026ndash;43. https://doi.org/10.1080/1536710x.2013.870512\u003c/li\u003e\n\u003cli\u003eFrank, R. G., Goldman, H. H., \u0026amp; Mcguire, T. G. (2001). Will parity in coverage result in better mental health care? \u003cem\u003eNew England Journal of Medicine\u003c/em\u003e, \u003cem\u003e345\u003c/em\u003e(23), 1701\u0026ndash;1704. https://doi.org/10.1056/nejm200112063452311\u003c/li\u003e\n\u003cli\u003eFulmer, T., \u0026amp; Chernof, B. (2018). Handbook of Geriatric Assessment. (5th ed.). Jones \u0026amp; Bartlett Learning, LLC.\u003c/li\u003e\n\u003cli\u003eFulmer, T., Reuben, D. B., Auerbach, J., Fick, D. M., Galambos, C., \u0026amp; Johnson, K. S. (2021). Actualizing Better Health And Health Care For Older Adults: Commentary describes six vital directions to improve the care and quality of life for all older Americans. \u003cem\u003eHealth Affairs\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(2), 219-225. https://doi.org/10.1377/hlthaff.2020.01470\u003c/li\u003e\n\u003cli\u003eGottlieb, L., Fichtenberg, C., Alderwick, H., Adler, N. (2019). Social determinants of health. \u003cem\u003eJournal of Healthcare Management\u003c/em\u003e, \u003cem\u003e64(4)\u003c/em\u003e, 243-257 \u003cu\u003ehttps://doi.org/10.1097/JHM-D-18-00160\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eGreysen, S. R., Hoi‐Cheung, D., Garcia, V., Kessell, E., Sarkar, U., Goldman, L., Schneidermann, M., Critchfield, J., Pierluissi, E., \u0026amp; Kushel, M.. (2014). \u0026ldquo;Missing Pieces\u0026rdquo;\u0026mdash;Functional, Social, and Environmental Barriers to Recovery for Vulnerable Older Adults Transitioning from Hospital to Home. \u003cem\u003eJournal of the American Geriatrics Society\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(8), 1556\u0026ndash;1561. https://doi.org/10.1111/jgs.12928\u003c/li\u003e\n\u003cli\u003eHayashi, M. (2013). The care of older people: England and Japan, A Comparative Study. \u003cem\u003eStudies For the Society for The Social History of Medicine\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(11). https://doiorg.utk.idm.oclc.org/10.4324/9781315654560\u003c/li\u003e\n\u003cli\u003eHIPAA Mental Health Parity Act of 1996, 62 FR 66967 (1996). https://www.govinfo.gov/content/pkg/FR-1997-12-22/pdf/FR-1997-12-22.pdf\u003c/li\u003e\n\u003cli\u003eHolt-Lunstad, J., Robles, T. F., \u0026amp; Sbarra, D. A.. (2017). Advancing social connection as a public health priority in the United States.. \u003cem\u003eAmerican Psychologist\u003c/em\u003e, \u003cem\u003e72\u003c/em\u003e(6), 517\u0026ndash;530. https://doi.org/10.1037/amp0000103\u003c/li\u003e\n\u003cli\u003eHsu, H. C., Liang, J., Luh, D. L., Chen, C. F., \u0026amp; Wang, Y. W. (2019). Social Determinants and Disparities in Active Aging Among Older Taiwanese. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(16), 3005. https://doi.org/10.3390/ijerph16163005\u003c/li\u003e\n\u003cli\u003eIrwin, A., \u0026amp; Scali, E. (2007). Action on the social determinants of health: A historical perspective. \u003cem\u003eGlobal Public Health\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(3), 235\u0026ndash;256.\u003cu\u003e \u003c/u\u003ehttps://doi.org/10.1080/17441690601106304\u003c/li\u003e\n\u003cli\u003eJoo, J. H., Jimenez, D. E., Xu, J., \u0026amp; Park, M. (2019). Perspectives on Training Needs for Geriatric Mental Health Providers: Preparing to Serve a Diverse Older Adult Population. \u003cem\u003eThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(7), 728\u0026ndash;736. https://doi.org/10.1016/j.jagp.2019.03.015\u003c/li\u003e\n\u003cli\u003eKemperman, A., Van Den Berg, P., Weijs-Perr\u0026eacute;e, M., \u0026amp; Uijtdewillegen, K. (2019). Loneliness of Older Adults: Social Network and the Living Environment. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(3), 406. https://doi.org/10.3390/ijerph16030406\u003c/li\u003e\n\u003cli\u003eKhazanov, G. K., Morris, P. E., Beed, A., Jager-Hyman, S., Myhre, K., McKay, J. R., Feinn, R. S., Boland, E. M., \u0026amp; Thase, M. E. (2022). Do financial incentives increase mental health treatment engagement? A meta-analysis. \u003cem\u003eJournal of consulting and clinical psychology\u003c/em\u003e, \u003cem\u003e90\u003c/em\u003e(6), 528\u0026ndash;544. https://doi.org/10.1037/ccp0000737\u003c/li\u003e\n\u003cli\u003eKoma, W., Cubanski, J., Neuman, T. (2021, June 4). \u003cem\u003eA snapshot of sources of coverage among Medicare beneficiaries in 2018\u003c/em\u003e. Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries-in-2018/\u003c/li\u003e\n\u003cli\u003eKorlagunta, K. (2011). Utilization of the socio-ecological model to evaluate older Oklahomans\u0026apos; abilty to grocery shop, prepare food and eat. \u003cem\u003eOklahoma State University. \u003c/em\u003e12-45. Retrieved Oct 02, 2021 from https://shareok.org/bitstream/handle/11244/6863/Department%20of%20Nutritional%20Sciences_12.pdf;jsessionid=E722618C8E3426FF4017349D91CFE2CB?sequence=1\u003c/li\u003e\n\u003cli\u003eKumar, R. (2013, August 15). Social determinants of health among elderly: an anthropological study (Publication No. ISSN 2321\u0026ndash;9548). \u003cem\u003eInternational Journal of Research in Sociology and Social Anthropology\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(1), 11-16.\u003c/li\u003e\n\u003cli\u003eLoo, B. P., Mahendran, R., Katagiri, K., \u0026amp; Lam, W. W. (2017). Walking, neighbourhood environment and quality of life among older people. \u003cem\u003eCurrent opinion in environmental sustainability\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e, 8-13. https://doi.org/10.1016/j.cosust.2017.02.005\u003c/li\u003e\n\u003cli\u003eLund, J. J., Chen, T. T., LaBazzo, G. E., Hawes, S. E., \u0026amp; Mooney, S. J. (2021). The association between three key social determinants of health and life dissatisfaction: A 2017 behavioral risk factor surveillance system analysis. \u003cem\u003ePreventive medicine\u003c/em\u003e, \u003cem\u003e153\u003c/em\u003e, 106724. https://doi.org/10.1016/j.ypmed.2021.106724\u003c/li\u003e\n\u003cli\u003eNewell, K. W. (Ed.). (1975). Health by the people. Swiss Francs Social Work. https://doi.org/10.1093/sw/21.3.256-a\u003c/li\u003e\n\u003cli\u003eOlder Americans Act of 1965, 42 U.S.C. ch. 35 \u0026sect; 3001 et seq. (1965). https://www.govinfo.gov/app/details/CREC-1996-09-06/CREC-1996-09-06-pt1-PgS10024-3\u003c/li\u003e\n\u003cli\u003ePavon, J. M., Fish, L. J., Col\u0026oacute;n‐Emeric, C. S., Hall, K. S., Morey, M. C., Pastva, A. M., \u0026amp; Hastings, S. N. (2021). Towards \u0026ldquo;mobility is medicine\u0026rdquo;: socioecological factors and hospital mobility in older adults. \u003cem\u003eJournal of the American Geriatrics Society\u003c/em\u003e, \u003cem\u003e69\u003c/em\u003e(7), 1846-1855. https://doi.org/10.1111/jgs.17109\u003c/li\u003e\n\u003cli\u003ePerez, F. P., Perez, C. A., \u0026amp; Chumbiauca, M. N. (2022). Insights into the Social Determinants of Health in Older Adults. \u003cem\u003eJournal of biomedical science and engineering\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(11), 261\u0026ndash;268. https://doi.org/10.4236/jbise.2022.1511023\u003c/li\u003e\n\u003cli\u003ePerez, F. P., Perez, C. A., \u0026amp; Chumbiauca, M. N. (2022). Insights into the Social Determinants of Health in Older Adults. \u003cem\u003eJournal of biomedical science and engineering\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(11), 261\u0026ndash;268. https://doi.org/10.4236/jbise.2022.1511023\u003c/li\u003e\n\u003cli\u003ePiolatto, M., Bianchi, F., Rota, M., Marengoni, A., Akbaritabar, A., \u0026amp; Squazzoni, F.. (2022). The effect of social relationships on cognitive decline in older adults: an updated systematic review and meta-analysis of longitudinal cohort studies. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1). https://doi.org/10.1186/s12889-022-12567-5\u003c/li\u003e\n\u003cli\u003ePoey, J. L., Burr, J. A., \u0026amp; Roberts, J. S.. (2017). Social Connectedness, Perceived Isolation, and Dementia: Does the Social Environment Moderate the Relationship Between Genetic Risk and Cognitive Well-Being?. \u003cem\u003eThe Gerontologist\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(6), 1031\u0026ndash;1040. https://doi.org/10.1093/geront/gnw154\u003c/li\u003e\n\u003cli\u003ePooler, J., \u0026amp; Srinivasan, M. (2018, May). Social determinants of health and the aging population. \u003cem\u003eIssue Brief. IMPAQ International\u003c/em\u003e.\u003cem\u003e \u003c/em\u003eRetrieved Oct 06, 2021 from https://impaqint.com/sites/default/files/files/Issue%20Brief_SDOHHandAgingPopulation.pdf\u003c/li\u003e\n\u003cli\u003eReynolds, C. F., 3rd, Jeste, D. V., Sachdev, P. S., \u0026amp; Blazer, D. G. (2022). Mental health care for older adults: recent advances and new directions in clinical practice and research. \u003cem\u003eWorld psychiatry : official journal of the World Psychiatric Association (WPA)\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(3), 336\u0026ndash;363. https://doi.org/10.1002/wps.20996\u003c/li\u003e\n\u003cli\u003eRook, K. S., \u0026amp; Charles, S. T. (2017). Close social ties and health in later life: Strengths and vulnerabilities. \u003cem\u003eThe American psychologist\u003c/em\u003e, \u003cem\u003e72\u003c/em\u003e(6), 567\u0026ndash;577. https://doi.org/10.1037/amp0000104\u003c/li\u003e\n\u003cli\u003eRosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., \u0026amp; Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. \u003cem\u003eThe American psychologist\u003c/em\u003e, \u003cem\u003e73\u003c/em\u003e(4), 433\u0026ndash;450. https://doi.org/10.1037/amp0000298\u003c/li\u003e\n\u003cli\u003eRowan, K., McAlpine, D. D., \u0026amp; Blewett, L. A. (2013). Access and cost barriers to mental health care, by insurance status, 1999-2010. \u003cem\u003eHealth affairs (Project Hope)\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(10), 1723\u0026ndash;1730. https://doi.org/10.1377/hlthaff.2013.0133\u003c/li\u003e\n\u003cli\u003eSaarloos, D., Kim, J. E., \u0026amp; Timmermans, H. (2009). The Built Environment and Health: Introducing Individual Space-Time Behavior. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(6), 1724\u0026ndash;1743. https://doi.org/10.3390/ijerph6061724\u003c/li\u003e\n\u003cli\u003eSivakumar, P. T., Mukku, S. S. R., Kar, N., Manjunatha, N., Phutane, V. H., Sinha, P., Kumar, C. N., \u0026amp; Math, S. B. (2020). Geriatric telepsychiatry: promoting access to geriatric mental health care beyond the physical barriers. \u003cem\u003eIndian Journal of Psychological Medicine\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(5), 41S\u0026ndash;46S. https://doi.org/10.1177/0253717620958380\u003c/li\u003e\n\u003cli\u003eStuart, H. (2016). Reducing the stigma of mental illness. \u003cem\u003eGlobal mental health (Cambridge, England)\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e, e17. https://doi.org/10.1017/gmh.2016.11\u003c/li\u003e\n\u003cli\u003eSubu, M. A., Wati, D. F., Netrida, N., Priscilla, V., Dias, J. M., Abraham, M. S., Slewa-Younan, S., \u0026amp; Al-Yateem, N.. (2021). Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. \u003cem\u003eInternational Journal of Mental Health Systems\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(1). https://doi.org/10.1186/s13033-021-00502-x\u003c/li\u003e\n\u003cli\u003eTeo, K., Churchill, R., Riadi, I., Kervin, L., Wister, A. V., \u0026amp; Cosco, T. D. (2022). Help-Seeking Behaviors Among Older Adults: A Scoping Review. \u003cem\u003eJournal of Applied Gerontology\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(5), 1500-1510. https://doi.org/10.1177/07334648211067710\u003c/li\u003e\n\u003cli\u003eTur-Sinai, A. (2022). Out-of-Pocket Expenditure on Medical Services Among Older Adults: A Longitudinal Analysis. \u003cem\u003eFrontiers in public health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, 836675. https://doi.org/10.3389/fpubh.2022.836675\u003c/li\u003e\n\u003cli\u003eWallace, P. M., \u0026amp; Sterns, H. L. (2022). Considerations of Family Functioning and Clinical Interventions. \u003cem\u003eGerontology \u0026amp; geriatric medicine\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e, 23337214221119054. https://doi.org/10.1177/23337214221119054\u003c/li\u003e\n\u003cli\u003eWest, K.H., Milne, A., Hotham, S. (2020). New horizons in supporting older people\u0026rsquo;s health and wellbeing: is social prescribing a way forward? \u003cem\u003eAge and Aging\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e, 319-326. https://doi.org/10.1093/ageing/afaa016\u003c/li\u003e\n\u003cli\u003eWickramaratne, P. J., Yangchen, T., Lepow, L., Patra, B. G., Glicksburg, B., Talati, A., Adekkanattu, P., Ryu, E., Biernacka, J. M., Charney, A., Mann, J. J., Pathak, J., Olfson, M., \u0026amp; Weissman, M. M.. (2022). Social connectedness as a determinant of mental health: A scoping review. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(10), e0275004. https://doi.org/10.1371/journal.pone.0275004\u003c/li\u003e\n\u003cli\u003eWoods, M. D., Kirk, D., Agarwal, S., Annandale, E., Arthur, T., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L., Riley, R., Sutton, A. (2005, April). Vulnerable groups and access to health care: A critical interpretive review. \u003cem\u003eReport for the National Co-ordinating Centre for NHS Service Delivery and Organisation R \u0026amp; D\u003c/em\u003e, 34-68.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2023, March 15). \u003cem\u003eDementia\u003c/em\u003e. World Health Organization Newsroom - Dementia. Retrieved (December 15, 2023), from https://www.who.int/news-room/fact-sheets/detail/dementia#:~:text=Key%20facts,injuries%20that%20affect%20the%20brain.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"older adults, accessibility, mental health, socioecological model, social determinants of health","lastPublishedDoi":"10.21203/rs.3.rs-4360005/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4360005/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFor older cohorts, there is decreased synergy between social determinants of health (SDoH), a sense of personal security, and knowledge about mental health conditions. The centrality of this paper is to discuss social constraints hindering the accessibility of older adults to mental health services. This paper further conceptualizes a multistakeholder socioecological model (ScEcM) with an adaptation of the social determinants of health framework and socioecological theory of human behavior. The model will aid social workers in less developed economies in tackling the stigma surrounding mental health by involving multilevel partnerships along with a focus on interpersonal constraints. This model is built by deliberating upon the role of public policies; the importance of socioecological factors such as interactions within the community and organization; and individual help-seeking behavior and other social deterrents that influence access to mental healthcare. The five stages of the model are identification, encouragement, integration, enrollment, and incentivization, which merge community-level participation with public policy and social security to counter the social elements that influence access to mental healthcare. Through a literature review, this paper introduces a fresh approach to posit a macro socioecological model that can help social workers address mental health inaccessibility in developing economies.\u003c/p\u003e","manuscriptTitle":"Improving Aging Mental Health Services in Developing Economies: A Socio-Ecological Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-10 21:25:48","doi":"10.21203/rs.3.rs-4360005/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9a5d030-cc2c-4d73-aaa6-078f5d14ae15","owner":[],"postedDate":"May 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-13T16:42:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-10 21:25:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4360005","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4360005","identity":"rs-4360005","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}