1 Marsha Frankel, LICSW Clinical Director of Senior Services-JF&CS Ruth Grabel, MPA Program Specialist and Coordinator, Massachusetts Partnership on Substance.
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Marsha Frankel, LICSWClinical Director of Senior Services-JF&CS
Ruth Grabel, MPAProgram Specialist and Coordinator, Massachusetts
Partnership on Substance Use in Older Adults Massachusetts Department of Public Health
April 10, 2013
Tips and Techniques for Supporting Residents with Mental Illness
(C)JF&CS of Greater Boston All rights reserved 2013
OBJECTIVES Be able to name 3 common mental health
problems in older adult residents Be able to identify at least 1 intervention
strategy Increased comfort in knowing about and
utilizing community resources to assist in managing mental health problems
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Impact on Staff What percentage of residents take up the
majority of your time?
How about the impact on other staff?
Impact on others?
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Instructions Write the name (first name or initials) of an
elder who you find the most challenging During the rest of this presentation think
about how or if the information relates to the older adult you identified
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Most Common Psychiatric Diagnoses of Older Adult Residents Dementia
Mood Disorders- Depression and Anxiety
Substance Abuse- especially alcoholism
Psychotic Disorders
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Basic Assessment Skills
Are there any significant changes in: Appearance Speech Physical Eye Contact Mood Cognition
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Dementia in Independent Senior Housing
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Dilemmas Safety vs. Autonomy
Elder’s rights vs. safety for others
Family dynamics
No family
When to call Protective Services and why(C)JF&CS of Greater Boston All
rights reserved 2013
DEPRESSION
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Depression is a Biological Illness
Reprinted from Mark George, MDBiological Psychiatry Branch, Division of Intramural Research Programs, NIMH,
1993
Non-Depressed Brain Depressed Brain
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Risk Factors for Depression
Genetics
Prior history of depression
Medical Illness/Medications
Psychosocial stressors
Cognitive: Behavioral and personality factors
Trauma
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Consequences of Depression
Adherence to medical treatment
Recovery from medical illness
Quality of life
Function and self-care
Social relations
Decrease in…
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Consequences of Depression Isolation
Use of health services
Risk of suicide and overall mortality
Incr
ease
in…
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JOHN
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Guidelines for Screening Start where the elder is Ask direct questions Express a belief that no one should suffer
needlessly Acknowledge how hard it is for anyone
to admit depression and to seek help
Hold out hope! Educate
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Rates of Suicide in Older Adults
Depression is the #1 risk factor for people who commit suicide
High rate of completed suicides occur in older adults
Elderly suicide may be under-reported by as much as 40%
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ANXIETY DISORDERS
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Substance Abuse
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Prescription Drug Misuse Approximately one third of all medications
prescribed in U.S. are for people over 65 Unintentional misuse Intentional abuse may be as high as 11%
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Alcohol Use and Abuse
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Suicide and Substance Abuse
Suicide= a leading cause of death among people of all ages who abuse alcohol and drugs
Depression= common co-occurring diagnosis of substance abusers
Acute alcohol intoxication exists in 30-40% of suicides and attempted suicides
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Psychosis
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Psychosis Up to 23% of all older adults will experience
psychotic symptoms
Dementia is the main cause in elders
Visual and auditory deficits play a role
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Identifying Potential PsychosisLook for changes in:
Social functioning
Cognition
Mood
Thought content
Alcohol/drug use
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Identifying Potential PsychosisLook for evidence of:
Poor personal hygiene
Delusional or bewildered mood
Abstract or vague speech
Sudden outbursts of anger or irritation
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Paranoia More than 12% with dementia experience
paranoid symptoms
Causes distress for elder and caregivers
Can be an acute mental status change
Ranges from increased suspiciousness to persecutory delusions
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Responding to Someone Experiencing Delusions
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It Takes a Village
Special project with JCHE
Lessons learned- the role of The Team
How to create a “village”
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Mrs. K
Mrs. K’s Story
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SiteRep
Mrs. K
Mrs. K’s Story
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SiteRep
RSCMrs. K
Mrs. K’s Story
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SiteRep
RSC
Police
Mrs. K
Mrs. K’s Story
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SiteRep
RSC
Maintenance
Police
Mrs. K
Mrs. K’s Story
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SiteRep
RSC
ResidentsMaintenance
Police
Mrs. K
Mrs. K’s Story
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SiteRep MH
Clinician
RSC
ResidentsMaintenance
Police
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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SiteRep MH
Clinician
RSC
ResidentsMaintenance
MD
Police
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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SiteRep MH
Clinician
RSC
Residents
ReducedFee
Attorney
Maintenance
MD
Police
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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SiteRep MH
Clinician
RSC
Residents
ReducedFee
Attorney
Maintenance
MD
Police
PublicHealthNurse
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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SiteRep MH
Clinician
FreeCare
Manager
RSC
Residents
ReducedFee
Attorney
Maintenance
MD
Police
PublicHealthNurse
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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PublicHealthNurse
Police
MD
PCA
MaintenanceReduced
FeeAttorney
Residents
RSC
FreeCare
Manager
MHClinician
SiteRep
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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SiteRep MH
Clinician
FreeCare
Manager
RSC
Residents
ReducedFee
AttorneyHospice
Maintenance
MD
Police
PublicHealthNurse
Mrs. K
Mrs. K’s Story
(C)JF&CS of Greater Boston All rights reserved 2013
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Conclusion
“Takes a village” Collaboration: identifying community partners Seek support
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