Mental Health and Aging in the 21 st Century
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1 Mental Health and Aging in the 21 st Century Bob G. Knight, Ph.D. University of Southern California» October, 2009
2 Forces for Changes in the 21 st Century Population Aging and the Aging of the Boomers Pop in millions
3 Forces for Changes in the 21 st Century Cohort Changes in Prevalence of Mental Disorders More Depression Higher Suicide Rates More Anxiety 1 0 Schizophrenia MDD Dysthmia Anxiety Substance Cognitive Impairment
4 Forces for Changes in the 21 st Century Cohort Changes in Demand for Mental Health Services Cohort Changes in the Histories of the Severely Mentally Ill Cohort Changes in Family Structure and Caring for Frail Elderly Multicultural Aging Advances in Treatments for Dementias?
5 Accurate Assessment and Diagnosis is a Major Issue Older adults have higher prevalence of dementias Older adults are very likely to have comorbid medical disorders Side effects of medication and medication interactions create diagnostic complexities Older adults in public system often have co-existing social services needs
6 Effectiveness of Psychological Therapy with Older Adults Psychological interventions for depression in older adults (mean d =.78, Scogin & McElreath, 1994) Medications for depression in older adults (mean d =.57, Schneider, 1994) Psychological interventions with younger adults or mixed age samples (range of mean d values:.65 to 2.15, Lambert & Bergin, 1994)
7 Evidence-based Treatments for Older Adults Behavioral problem solving therapies (ABC analysis and increase pleasant events) and individualized approaches that progressively lower stress levels through problem solving and environmental modification for dementia patients Cognitive behavioral, behavioral, cognitive bibliotherapy, problem solving therapy, reminiscence therapy and psychodynamic therapies for clinical depression Relaxation training, cognitive behavioral therapy, (less evidence for cognitive therapy, and supportive therapy) for anxiety Sleep restriction/sleep compression therapy and Multicomponent cognitive-behavioral treatment for insomnia Psychoeducational, psychotherapy, and multi-component interventions for caregivers of frail older adults Taken from March, 2007, special issue of Psychology and Aging; depression from Scogin et al. (2005) Clinical Psychology: Science and Practice.
8 Factors that Influence Outcomes with Older Adults Psychotherapy versus psychosocial interventions Clients depressed vs. at risk before therapy started Number of sessions (> 9) Qualifications of therapist Young-old participants (<77)* Nursing home resident * * effect reversed for measures of subjective well being Taken from Pinquart & Sorenson (2001) J of Mental Health and Aging
9 Older Adult Populations in Need of Mental Health Services Severely mentally ill older adults Acutely distressed older adults Older adults with dementia Older adults with substance abuse
10 Older Clients Are Often Embedded in Multiple Systems of Care Mental Health System Acute Medical Care System Long Term Care System Aging Network of Services Dementia Care Network
11 Separate Systems Rather than One System with Cracks At best, these are multiple systems. Some components may contain multiple subsystems Different histories and cultures Different rules for how patients/clients move through each system In the cost-cutting political climate, often in direct conflict with one another
12 Key Features of Model Programs in Community-based Services for Older Adults Interdisciplinary teams Focus on active treatment Home-based service delivery Active case-finding methods Community education Interagency collaboration From Knight, Rickards, Rabins, Buckwalter & Smith, 1995
13 Aspects of Service Delivery Mobile services: in home, in community settings, in primary care medical settings, in long term care: follow the patient Crisis service capability Community education to enhance services for older clients Bilingual/bicultural: Spanish, others?
14 Service Delivery (con t) Expert assessment and diagnosis Active treatment: medication and psychological interventions Medication consultations from psychiatrist or pharmacologist
15 Professional Responses Greater Specialization Improving Assessment of Problems of Elderly Changes in Treatment? Recognition of the Medicare Market
16 Health and Mental Health System Responses Mental Health and Long Term Care for Elderly Mental Health and Prison Populations Substance Abuse Services for Older Adults Despecialization of Care Mental Health Care in Medical Care Settings Mental Health Care in Community Settings Mental Health Care in Religious Settings
17 Realistic Collaboration Best models of collaboration are often informal Think in terms of loosely coupled systems Client-centered, case-focused solutions Try to avoid spinning your wheels tackling abstract organizational dilemmas
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