Service use and mental impairment among the elderly: Arguments for consultation and education.

Compared the service use patterns of older adults with varying levels of mental impairment, and assessed the effects of services received on their mental health status over a 1-yr period. Data were obtained from a US General Accounting Office (1977, 1979) study of 531 elderly persons (mean age 76.1 yrs), which included administration of a modified version of the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Ss were interviewed twice, 1 yr apart. 174 Ss were classified as having a mild psychiatric impairment, and 118 Ss had a severe psychiatric impairment. The existence of mental impairment was related to marital status, race, and level of education. Usage of mental health services was low, although mentally impaired Ss were more likely than unimpaired Ss to use social and medical services. Results also suggest that such services can have an important effect on the mental health of older persons. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging and mental health: Business as usual?

Cautions that in developing training models in mental health and aging, psychologists must not overlook what experience has taught them about mental health intervention or what they know already about older adults. It is suggested that a life-span developmental view complements a community and preventive approach to the mental health needs of the elderly. Creation of a separate subspecialty of clinical geropsychology will not effectively serve older adults. What is needed is a synthesis of already existing expertise in areas such as life-span development, clinical psychology, and community psychology. This synthesis provides a conceptual foundation and set of intervention approaches on which to base training programs in mental health and aging. (61 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Loss of control and the chronic mentally ill in a rural day-treatment center

The bioartificial pancreas was designed to incorporate islet tissues and a selectively permiable membrane that isolates islets from the immune system of the recipient. The efficacy of agarose, a nontoxic polysaccharide, has been evaluated as a material of microcapsules to prevent allo- and xenograft rejection in rodents. The aim of this study is to demonstrate the possibility of the agarose microcapsule containing allo-islets as a bioartificial pancreas in canine model. In vitro viability of islets was determined by glucose challenge during perifusion experiments (n = 4). Insulin secretion from both encapsulated (enc.) and non-encapsulated (non-enc.) canine islets rose from initial basal levels of 0.09 (encap.), 0.07 (non-encap.) to the peak of 0.2 (encap.), 0.1 (non-encap.) in microU/islet/min after 5 minutes, then decreased to the basal level when the glucose challenge was discontinued. Auto-transplantation was performed in two dogs to evaluated in vivo viability and biocompatibility of encapsulated islets implanted into the splenic sinus by venouse reflux. Two weeks after auto-transplantation, the plasma insulin levels in the splenic vein and artery of two dogs were assayed. In the first dog, serum insulin level was 1 microU/ml both in the vein and the artery and increased, after glucagon (1.0 mg) injection, to levels of 9 microU/ml in the vein, but still kept 1 microU/ml in artery, as well as in the second one. Histological and electron-microscopical examination of the spleen revealed that encapsulated islets remained morphologically intact and the surface of agarose capsules showed no significant adherence of fibroblasts and inflammatory cells. Functional efficacy of the microencapsulated islets was determined using five totally-pancreatectomized diabetic dogs as recipients without immunosuppression. Defined quantity of microencapsulated islets from outbred mongrel donors were grafted through the catheter into omental tissue of the pancreatectomized recipients. All dogs had various degrees of reduced insulin requirements. In three of five recipients, the average fasting glucose values were controlled under 120 mg/dl for 28, 42, 49 days without exogenous insulin, which received totally 4.3 x 10(3), 7.3 x 10(3) and 1.0 x 10(4) (IE/kg) of microencapsulated islets, respectively. In conclusion, the present study indicates that the agarose-based microencapsulated islets can function in large diabetic animals, resulting in the independence of exogenous insulin therapy for prolonged periods without the need for immunosuppression.     

The mental health system and older adults in the 1990s.

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather, the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stay safe! Stay healthy! Surviving old age in prison

Although elderly inmates form a small minority in the U.S. prison population (6.6%), this number is expected to increase by 2005. Elderly prisoners consist of first-time offenders, habitual offenders, and those who have "aged in place" (received very long sentences at a young age). Violence is an identified stressor affecting the elderly prisoner. This enduring stressor can add to physical deterioration, particularly in the inmate with chronic illness. Violence in prison falls into three categories: prisoner-prisoner, staff-prisoner, or prisoner-staff (Clear & Cole, 1994). Prisoner-prisoner incidents account for the majority of violence within prison systems. The convict in today's prison will use extremes of violence to combat threats to his or her reputation or self-concept of "machismo," or if the inmate feels "disrespected." The aging prisoner may have chronic, pervasive stress levels disguised under a tough veneer, although he or she may no longer be strong enough physically or emotionally to fend off potential attackers. Interventions with elderly prisoners include thorough physical and cognitive assessment, including signs and symptoms of depression or stress related to environmental disturbances. Educational training for correctional staff about age-specific developmental changes is necessary. Building partnerships with community, state, and national organizations can assist elderly inmates in their adjustment to prison and foster successful community release programs. Special care units may be considered for frail elderly inmates or those with chronic health problems.     

Strategies for maintaining optimal wellness in the chronic mentally ill

TOPIC: Ways the chronic mentally ill avoid loss of control and the importance of both the therapeutic environment and the nurse-patient relationship in helping them do this. PURPOSE: To examine the strategies people with chronic mental illness use to prevent loss of control and maintain health, and ways nurses can help with this process. SOURCE: Findings from a previously published study of seven chronically mentally ill clients in a rural day-treatment center. CONCLUSIONS: Four properties related to the core variable of "preventing loss of control" are relationships, feelings, good attitude, and functional activity. These properties must be examined within the context of the therapeutic environment as well as the nurse-patient relationship.     

Unintended consequences of requiring a license to help.

Comments that current proposals for licensure, accreditation, and 3rd-party reimbursement may have several unintended consequences. Until now discussion has focused on the effects of the proposed regulations on the development of psychology as a profession. Recent proposals, however, may have unexpected adverse consequences on 3 other areas as well: the education of professionals within psychology, the delivery of psychological and other helping services, and the self-definition of the consumer of psychological services. Any changes in licensure, accreditation, and reimbursement require compromises of concerns for the profession, for the consumer, and for psychologists' livelihood. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing homes as a setting for psychological practice: Public policy perspectives.

Recent federal legislation has provided renewed interest in improving the quality of nursing home care. The lack of both funding and personnel are significant barriers that may keep psychology's disciplinary expertise from being fully used in nursing homes. Nursing homes may be forced to undertake mandated activities (e.g., preadmission screening, nurses aides' training, and evaluation) without psychologists' expertise, relying either on medical practitioners with little knowledge of mental health interventions or on minimally qualified, entry-level mental health workers. Advocates for improved nursing home care must see the links among basic disciplinary skills, interdisciplinary collaboration, and improved care for mentally impaired elderly individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)