An overview of mental health services for the elderly

Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.     

Restructuring long-term care and the geography of ageing: a view from rural New Zealand

This paper examines the major points of contact between the restructuring of long-term care and the evolving geography of the elderly in the Waikato, one of New Zealand's agricultural heartlands. The time frame of the study is 1981-91, a decade in which new Zealand embarked on a sweeping program of service restructuring and privatization. Comparative analysis of data on the evolving distribution of the elderly and on the shifting supply of long-term care beds reveals that restructuring has sharpened contrasts between urban and rural contexts for ageing. Almost all the urban centres in the Waikato benefited from an expansion of long-term care driven by private-sector initiatives, while rural communities suffered a broad-based depletion of services. However, the data indicate that, contrary to the trend in long-term care, more older elderly people (defined as those aged 80 or older) are "staying on' in rural communities. The paper concludes with a consideration of emergent policy issues; we speculate that it through the aggregate outcomes of decisions to "stay on' that the personal troubles of the elderly residents of service-depleted communities may yet become an important policy issue in rural New Zealand.     

Teaching cultural competence. The value of experiential learning and community resources

Nurse educators are responsible for developing graduates who are culturally competent care givers and marketable as culturally sensitive coworkers. An undergraduate course in transcultural nursing is described that relies heavily on experiential learning activities and local community resources. Student evaluations reveal both immediate and long-term effects of this course on graduates' clinical practice.     

A solution to the problem of jail suicide

In American studies in the sixties and seventies caregivers, including physicians, showed a negative attitude towards the elderly. There are indications that such a negative attitude affects the quality of care and the communication with the elderly. Based on predominantly American literature this article reviews research on medical students' knowledge about and attitudes towards older people as well as the impact of geriatric training on the image of older patients and physician-patient communication. In medical students who did not receive a geriatric training, attitudes improved in the eighties and nineties up till a slightly positive level but general gerontological knowledge displayed as many shortcomings as in former days. A few studies show that instructional modules in geriatrics do not have an impact on the attitude towards the elderly. Several studies show that contact with aged persons has a positive influence. Rather than geriatric residency or work in a nursing home, contact with healthy elderly has favourable effects. Attitude improvement based on interactions with older people is maintained during medical education. A program in gerontology as well as geriatric instructional modules can lead to knowledge improvement. Since significantly positive correlations between knowledge and attitude are sometimes demonstrated, increasing gerontological knowledge may lead to more positive attitudes.     

Care for Canada's frail elderly population: fragmentation or integration?

Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.     

The link between knowledge and remembering in Alzheimer''s disease

This article presents results from a retrospective study of psychological assessments of elderly persons with chronic mental illness residing in nursing homes. All residents (N = 570) received this assessment as part of federally mandated screening for mentally ill persons residing in long-term care. The process, the Preadmission Screening and Resident Review, was mandated by the Omnibus Budget Reconciliation Act (OBRA 87). These assessments were the first stage in a process to determine if the nursing home was the most appropriate placement for each resident. If nursing home care was deemed appropriate, then a psychological treatment program was to be established within the nursing home setting. The sample ranged in age from 50 to 104 (mean of 70). The majority had a diagnosis of schizophrenia and a history of psychiatric hospitalization occurring early in their life. The assessments did not include any quantifiable data on activities of daily living, cognitive functioning, or level of psychiatric impairment. Therefore, the researchers coded the narrative data so that it could be interpreted. The majority functioned within the none-to-mild range of cognitive impairment, and very few were completely dependent in the need for physical care. The most recorded symptom was social withdrawal. Neuroleptic medications were administered to 64% of elderly persons with chronic mental illness. Importantly, there was no relationship between demographic or clinical information and treatment recommendations. Implications of these findings for psychiatric nurses are discussed.     

Psychologists' role in the provision of mental health care for the elderly.

7,326 clinical and counseling psychologists were sent a 3-page questionnaire that requested information regarding attitudes toward, knowledge of, and practices with mature and older adults. The response rate was 19%. Results indicate that although psychologists may have some stereotyped impressions of the aged, they generally have some basic knowledge about the aging process. They are interested in learning more about this area and are interested in seeking out aged clients so that adequate care may be provided. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of water balance in ageing in health and disease

The elderly are at increased risk of changes in body water and sodium, often accompanying comorbid disease states, which are associated with increased mortality. The clinical assessment of the hydration status of an elderly patient is difficult and the elderly care physician relies on both the clinical picture and laboratory investigation. Although still contentious, research suggests that the elderly may appreciate thirst less readily. However, healthy elderly may be able to produce an enhanced vasopressin response to osmotic stimulation compared to their younger counterparts, possibly in response to reduced renal function. The changes in these systems, when combined with coincident disease, place elderly patients at risk of water imbalance and electrolyte disturbance.     

Paternal influences and the father's role: A personal perspective.

Briefly reviews research and theory concerning the role of the father in child development and presents a personal perspective that sees some long-established attitudes toward child care changing. Traditionally, major responsibility for childrearing has been assumed by women. Studies show, however, that most infants become attached to both their parents, although most turn to their mothers when distressed. With older children, fathers appear to have their greatest influence on sex role development. The type and extent of their impact varies depending on the quality of the father–child relationships. Recent trends indicate an increasing involvement of fathers in child care. These trends will increase paternal contributions to the socialization process. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vitro metabolism of cyanohydroxybutene: formation of a glutathione-S-transferase catalyzed product

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.     

The lubricating ability of biomembrane models with dipalmitoyl phosphatidylcholine and gamma-globulin

This paper describes the process of involving health professions students in research in rural primary care and how their research has contributed to the development and expansion of a rural community health center. Since 1978 over 400 students have completed rotations at the center, and more than 200 have been health profession students, including medical, nursing, physician assistant, pharmacy, and health administration students. A total of 96 research projects were completed. These projects lie in two main areas: medical services and community outreach. Those related to medical services include measures of access to care, quality of care audits, clinical guideline development, practice patterns, prevalence studies, and qualitative research. Projects focusing on community outreach include community surveys, screening follow-ups, program evaluation, and program development. Principles that guide the selection and conduct of research projects include: Projects should be directly related to important work of the practice and reflect an interest of the student; projects are structured to include some or all of the following: literature search, data analysis, a visual display of quantitative information (table or graph), and application of relevant statistical tools; the student has a project supervisor; the student is a participant rather than an independent investigator; and a research flow sheet is used to orient students and NRHA staff to the larger research effort. Students are expected to present results, conclusions and recommendations to an appropriate group. Student research has made a significant contribution to both practice activities and practice policies.     

The representation of women, the elderly and minorities in Canadian television commercials.

Performed a content analysis on 1,733 TV commercials shown on 3 Canadian TV networks during an 8-wk period in the spring of 1983. Data were coded in terms of voice-overs, central characters, product type, locale, and the appearance of elderly and visible minority characters. Results indicate that men accounted for over 88% of voice-overs. For those commercials having an identifiable central character, 35% were female. Of these, 54% were supported by a male voice-over. Fewer than 2% of all commercials included elderly people as central characters, and elderly males outnumbered elderly females by a ratio of 2 to 1. Visible minorities were shown in fewer than 4% of all commercials. When present, they were usually males playing secondary roles. A comparison of the present findings with previous research suggests that little has changed in the representation of women in the last 10 yrs. Data are discussed in the context of TV's potential role as an influencer of behaviors and attitudes. (French abstract) (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A geriatric medical residency program. A four-year experience

Geriatricians are needed to further improve the health care of elderly Americans. The first formalized geriatric residency program in the United States was developed at the Mount Sinai City Hospital Center in New York, and this has produced a second program at the Jewish Institute for Geriatric Care at Long Island Jewish-Hillside Medical Center, New Hyde Park, New York. The goals of this training are to develop special clinical skills to deal with the medical and psychosocial problems of the elderly, and to achieve the ability to develop health care systems for the elderly. Emphasis is on a multileveled system, including home, outpatient, acute hospital, convalescent unit, and long-term institution care. The training period is 12 to 24 months, after an initial 24 to 36 months of standard internal medicine, thus fulfilling the requirements for board eligibility in internal medicine.     

Experiences of parents of children with congenital limb differences with health care providers: A qualitative study.

This article describes a qualitative, participatory action research study based in grounded theory, in which an online survey was developed and utilized to explore and generate suggestions for further research about the needs and health care experiences of parents of children with congenital limb differences (CLD) during the first year of the child’s life. Participants: Fifty parents completed an online survey that was developed through review of themes in the literature and input from people with CLD and their families. Primarily with open-ended questions, the survey targeted the respondents’ perceptions of the attitudes and approaches of health care providers. Results and Discussion: Results indicate that parents consistently commented on three main areas of interaction with health care providers: attitudes, information, and emotional or psychological support. Research hypotheses generated from the data are presented. Implications and suggestions for future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The health and welfare system for elderly in France

Dichotomy is the main characteristic of the Health and Welfare system in France. This system lies on two distinct fields, the medical field which is managed by the National Government, and the social field managed by the Local Government. The French home care policy for the elderly has developed a large number of services to assist in activities of daily living, to provide nursing and medical care at home, to improve living conditions, to maintain social relationships, and to postpone institutionalization and hospitalization, respectively. The main home care service is represented by "home helpers" who provide maid Notiniralics services. The second widely used service is the "home care service" performed by a team of nurses, assistant-nurses, psychologists, physiotherapists. This team provides nursing care and assistance in activities of daily living. As for institutions for the elderly, they are divided into welfare and medical institutions. The welfare institutions include social establishments like shelter homes and nursing homes. The medical institutions are mostly represented by long-term care hospitals. One of the main goals of the aging policy is to create medical wards in welfare institutions in response to the increased dependency of the institutionalized elderly. Recent experimental and innovative concepts have been established, such as "shelter homes for dependent elderly" for physically or cognitively impaired elderly.     

Working conditions in home care: negotiating race and class boundaries in gendered work

Home care work in metropolitan areas is a source of employment for immigrant women of color. Service work of this type intertwines domestic and caring labor in ways that reinforce the historically gendered and racialized nature of the work. Such macro level economic and political issues are played out at the micro level of daily service provided within elderly clients' homes. A study of these processes in home care work was carried out in urban southern Ontario in two nonprofit home care agencies. In-depth interviews and focus groups held with visible minority home care workers suggested that workers deal daily with racist attitudes and behaviors from clients and their families; agencies recognize these oppressive processes but usually handle them on a case-by-case basis through supervisors; and home care workers handle racism on the job as they do in their off-work hours-by avoidance, situating incidents within an analysis of the circumstances of elderly clients, setting boundaries on discussions, and occasionally, confrontation.     

Late-life depression in primary care: where do we go from here?

One quarter of elderly patients in the primary care physician's office experience serious depressive symptoms. Despite efforts over the past 20 years to increase detection of late-life depression in primary care settings, patient outcomes have not improved. Undertreatment remains seriously problematic. Current efforts to improve recognition have included the development of depression practice guidelines, Depression Awareness Recognition and Treatment (D/ART) program, educational programs, and rudimentary outcomes measures. Screening tools for depression, such as the Geriatric Depression Scale, the Center for Epidemiologic Studies--Depressed, and Cornell Scale for Depression in Dementia, have also been developed to help clinicians screen for depressive symptoms in both ambulatory and inpatient settings. However, to improve clinical outcomes, increased research efforts should focus upon physicians' attitudes and practice patterns, effective treatments for minor depression, and effective ways to assess patients' perceptions of depression, as well as ways to identify age-specific barriers to treatment adherence. In addition, incorporating valid outcome measures into the primary care clinical setting will be crucial to measure the impact of our treatments.     

Psychiatrists' and internists' knowledge and attitudes about delivery of clinical preventive medical services

OBJECTIVE: Changes in the health care environment have placed a greater responsibility on psychiatrists to deliver basic primary care services. The study assessed baseline knowledge and attitudes about clinical preventive medical services among psychiatric faculty and psychiatric residents at a tertiary care medical center. METHODS: Residents and faculty in psychiatry and general internal medicine completed a structured questionnaire, including 20 case scenarios, that assessed their baseline knowledge of clinical preventive medical services, their attitudes concerning delivery of those services, and their beliefs about the effectiveness of those services in changing patients' behavior. The case scenarios and knowledge questions were based on the clinical preventive medical services recommendations outlined by the U. S. Preventive Services Task Force. RESULTS: Psychiatrists reported more frequent assessment of and counseling about the use of illicit drugs and weapons, and internists were more likely to query about measures related to physical health such as cancer screening and immunizations. The two groups reported similar attitudes toward the need for and the efficacy of preventive medical services. Commonly cited barriers to the delivery of preventive care included lack of time and education. Psychiatrists scored reasonably well on baseline knowledge about guidelines for preventive medical services, particularly given their recent lack of specific education in these matters. CONCLUSIONS: Psychiatrists believe clinical preventive services are important and express interest in their delivery. Additional educational interventions are needed to train psychiatrists in clinical preventive services to avoid missed clinical opportunities for intervention in psychiatric populations that may have poor access to other medical care.     

Enhancing breast cancer screening in the university setting

Mammography, physical examination by a health care professional, and breast self-examination (BSE) may increase the probability of detection of breast cancer at an early stage and thus increase long-term survivor rates. The purpose of this study was to investigate the effectiveness of supportive coaching as an intervention to enhance compliance with these breast cancer screening guidelines. The following research questions were identified: (a) what are the attitudes of women toward breast cancer screening? (b) what are the barriers to compliance identified by women in breast cancer screening? and (c) what are the effects of supportive interventions by a professional nurse and of compliance with breast cancer screening in women? A quasi-experimental design was used to study the research questions. The population chosen for the study included female employees in a state university setting. Participants were randomly assigned to one of two groups. All participants were asked to complete a prestudy questionnaire measuring attitudes and beliefs, gathering demographic and health information, and surveying breast cancer screening practices. The experimental group then received coaching and supportive interventions over the course of the academic year. The remainder of the sample served as a control group. A poststudy questionnaire was then sent to the entire sample to identify behaviors related to breast cancer screening. A variety of beliefs and attitudes were observed in the groups. No significant difference was found between the experimental and control groups on compliance with mammography and the clinical breast examination. A difference was noted on compliance with BSE by the experimental group evidencing more compliance.