1 Marsha Frankel, LICSW Clinical Director of Senior Services-JF&CS Ruth Grabel, MPA Program Specialist and Coordinator, Massachusetts Partnership on Substance.

1

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

(C)JF&CS of Greater Boston All rights reserved 2013 2

3

Impact on Staff What percentage of residents take up the

majority of your time?

How about the impact on other staff?

Impact on others?


4

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


5

Most Common Psychiatric Diagnoses of Older Adult Residents Dementia

Mood Disorders- Depression and Anxiety

Substance Abuse- especially alcoholism

Psychotic Disorders


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


8

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


12

Consequences of Depression

Adherence to medical treatment

Recovery from medical illness

Quality of life

Function and self-care

Social relations

Decrease in…


13

Consequences of Depression Isolation

Use of health services

Risk of suicide and overall mortality

Incr

ease

in…


JOHN


15

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


16

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%


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%


20

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


22

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


25

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”


29

Mrs. K

Mrs. K’s Story


30

SiteRep

Mrs. K

Mrs. K’s Story


31

SiteRep

RSCMrs. K

Mrs. K’s Story


32

SiteRep

RSC

Police

Mrs. K

Mrs. K’s Story


33

SiteRep

RSC

Maintenance

Police

Mrs. K

Mrs. K’s Story


34

SiteRep

RSC

ResidentsMaintenance

Police

Mrs. K

Mrs. K’s Story


35

SiteRep MH

Clinician

RSC


Police

Mrs. K

Mrs. K’s Story


36

SiteRep MH

Clinician

RSC


MD

Police

Mrs. K

Mrs. K’s Story


37

SiteRep MH

Clinician

RSC

Residents

ReducedFee

Attorney

Maintenance

MD

Police

Mrs. K

Mrs. K’s Story


38

SiteRep MH

Clinician

RSC

Residents

ReducedFee

Attorney

Maintenance

MD

Police

PublicHealthNurse

Mrs. K

Mrs. K’s Story


39

SiteRep MH

Clinician

FreeCare

Manager

RSC

Residents

ReducedFee

Attorney

Maintenance

MD

Police

PublicHealthNurse

Mrs. K

Mrs. K’s Story


40

PublicHealthNurse

Police

MD

PCA

MaintenanceReduced

FeeAttorney

Residents

RSC

FreeCare

Manager

MHClinician

SiteRep

Mrs. K

Mrs. K’s Story


41

SiteRep MH

Clinician

FreeCare

Manager

RSC

Residents

ReducedFee

AttorneyHospice

Maintenance

MD

Police

PublicHealthNurse

Mrs. K

Mrs. K’s Story


42

Conclusion

“Takes a village” Collaboration: identifying community partners Seek support


1 Marsha Frankel, LICSW Clinical Director of Senior Services-JF&CS Ruth Grabel, MPA Program Specialist and Coordinator, Massachusetts Partnership on Substance.

Documents

john cjfcs of greater

autonomy elders rights

older adults depression

common mental health

risk factors

biological illness

percentage of residents

substance use