THE BEHAVIORAL KALEIDOSCOPE OF GERIATRIC CARE: AN … · 2018. 4. 4. · Schizoaffective Disorder...

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Presented by: Novant Health Thomasville Medical Center-Geriatric Behavioral Health – Therapy Department

May 2016

Novant Health/NASW-NC Clinical Institute 2016

Nothing to disclose


Enlighten and increase awareness of the urgent need for acute geriatric care given the exponential rise of the population and the lack of behavioral health resources. In general, this population is underserved and their issues are complex. Our therapeutic team realized there are three pertinent areas that are a must in addressing the needs of this age population.

Learning Objectives:

Better understand how acute psychiatric treatment serves the aging population and the community at large.

Take home examples and ideas for therapy groups that really work in the inpatient geriatric setting.

Identify the necessary skills, “Super Powers,” for any therapist to deliver best treatment outcomes.


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Statistics

Underserved Population

Silver Tsunami


General Aging Stats:

By 2050, the expected total population of U.S. citizens 65+ years old will reach 88.5 million (Aging and Long-Term Care: A Comprehensive Review)

Approximately 1 in 5 will belong to this age group in 2050.

Today the number is 1 in 7.7. The expected growth for the elderly population will far exceed the growth in younger age groups (Aging and Long-Term Care: A Comprehensive Review)

Mental Health Stats:

Approximately 15% of adults aged 60 and over suffer from a mental disorder (World Health Organization)

The most common neuropsychiatric disorders for this age group are dementia and depression

Dementia Stats:

1 in 3 seniors dies with Alzheimer’s or another Dementia (alz.org)

Every 66 seconds someone in the U.S. develops Alzheimer’s disease (alz.org)



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Mary Bethel, of the North Carolina Coalition On Aging, reports:

1 in 5 adults in North Carolina – over 2 million people – are age 60 and over

170,000 people are age 85+

By 2018 people 60 and over will outnumber people 0-17 in the state as a whole, and 90

of the 100 North Carolina counties.

World Health Organization:

1 in 4 adults are diagnosed with a mental disorder (World Health Organization)

Around 20% of people 55+ years old experience a mental health concern, with the

most common conditions being anxiety, severe cognitive impairment, and mood

disorders.

Centers for Disease Control:

The younger aging (50-64 years old) reported a higher lifetime diagnosis (12.7% vs.

7.6%) of anxiety disorder than adults aged 65+ (CDC)

The CDC also reports that NC has one of the highest reported frequent

mental distress rates of all 50 statesNovant Health/NASW-NC Clinical Institute 2016

Community Hospitalso Carolinas HealthCare System Northeast 10 beds

o Davis Memorial 10 beds

o St. Luke’s 10 beds

o NHFMC 11 beds

o Old Vineyard 12 beds

o NHRMC 19 beds

o UNC Healthcare 15 beds

o Thomasville Medical Center 45 beds

State Hospitals

o Cherry 20 beds

o Broughton 38 beds

o Central 40 beds


In North Carolina, 28 counties do not have a psychiatrist, 18 counties have 1 psychiatrist, 70 counties do not have a child/adolescent psychiatrist, Only SIX counties in NC have a geriatric psychiatrist, only five counties have an addiction psychiatrist (Source: The Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill. See the Excel spreadsheet for physician specialties. On the Internet at

http://www.shepscenter.unc.edu/hp/prof2011.htm.


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o55 & older

oDanger to self or others

and at least one of the following found in inquiry process:

oNon-compliance with ongoing treatment regime

oDecrease in ADL’s

oIncrease confusion

oIncrease agitation/aggressiveness

oPsychotic break

oSignificant changes intake/significant changes in sleep

oMedical clearance


• 281 Inquiries

• 69 Admitted (25%)

• 22 No Space Available

• 56 Chose Another Facility

• 23 Physician Declined

• 22 Medically Unstable

• 53 Did Not Meet Criteria

• 70 Discharges

• 1305 Patient Days

• 42.1 Average Daily Census

• 16.2 Average Length Of Stay

• 60 Contacts

• 76% Medicare



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https://https://www.youtube.com/watch?v=pM_ zoqjUL38


2008-80% were white non-Hispanic, 8.3% were black, less than 1 % American Indian/Alaska Native,

Asian/Pacific Islander;6.8% Hispanic; and 0.6% reported two or more races (US Census Bureau,2009)

2020- the minority population is expected to grow to 12.9 million or 23.6% of those 65+. Roughly 13 % of

foreign-born elders speak a language at home other than English: 38% Spanish, 44% Indo-European

languages, and 14% Asian and Pacific Island languages (US Census Bureau, 2004)

In Aging

U.S. population is growing older and increasingly

diverse, nearly 39 million people are currently 65 years

and older, and 19.6% are considered ethnic minorities.


Demographic Disparities:The elder population tends to be “Bimodal” in terms of income, education and social

status very high income/education vs very low income/education: most ethnic elders

exist between the two extremes. Elder immigrant and refugees who have lived in the

US longer are better off than recent immigrants and refugees. (Handbook , 2012)

Elder women, in general, tend to face societal inequities as they age, living alone,

suffering from multiple chronic health conditions, lower incomes, or living at or near the

poverty line. (Handbook , 2012)

Elderly men have the highest suicide rate of any other groups (CDC)

The ratio of suicide attempts to suicide death in youth is estimated to be about 25:1,

compared to about 4:1 in the elderly.

Firearm suicide used to be primarily a phenomenon limited to men, but the incidences

of women shooting themselves have been increasing.


https://www.youtube.com/watch?v=pM_zoqjUL38

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Case One (55-65 years old)

55 year-old male, depression, suicide with a plan, Parkinson’s Disease

Case Two (66-76 years old)

66 year-old male, Frontotemporal Dementia

Case Three (77+ years old)79 year-old female, Bipolar

Case Four (61 year old female)Schizoaffective Disorder Bipolar Type


Repeat “Customer”

Learned Helplessness

Developing appropriate aftercare plan in light of an

abusive home environment


Treatment goals included:

Assessing and treating the cause of the aggressive behaviors

and psychosis in the midst of complex medical problems

Developing the best discharge plan given his family

dynamics, cost of care, safety at home vs. safety at a

facility, and helping him accept the terms of the

discharge plan

Supporting and educating the family during this traumatic time


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New Onset of Manic Symptoms

Treatment/Managed Care/Level of Care

Discharge Planning


Delusional Thinking

Aggression

Suicidal Ideations

Medical Issues and Diet

Humor

ArtNovant Health/NASW-NC Clinical Institute 2016


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What I Actually Do

Recreational Therapy


• Problem Solving

• Social Skills

• Community Awareness

• Communication

• Anger Management

• Cognitive Stimulation

• Reminiscence

• Positive Thinking

• Reality Orientation

• Coping Skills

• Stress Management

• Relaxation Skills

• Leisure Education

• Leisure Skill Development

• Wellness Education

• Exercise


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• Art

• Therapeutic Drumming

• Tai Chi

• Wellness Garden

• Spirituality

• Pet Therapy


oAssertive Communication

oStress Management

oRelaxation Techniques

oReminiscence

oGrief and Loss

oCognitive – Behavioral

oMindfulness

oSocial problem solving and Interpersonal Skills

oExpressive Arts


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Therapy Team

“Teamwork Makes the Dream work” –John C. Maxwell


o Humoro Patience o Flexibilityo Boundaries o Compassiono Open Mindednesso Using Validation o Safety Awarenesso Delight in the Cliento Enjoyment in small victorieso Integration of mind, body, spirit o Respectful Communicationo Being Human vs Being Perfecto Engage the family as part of the

treatment team

o Talk about WE when working with

patients (we are in this together, we

need each other, the human journey)

o Developing rapport in order to help

communicate difficult news

o Awareness of medical issues

o Keep the inner rebel ALIVE

o Being a good detective

o Commitment to Self Care

o Realistic Expectations

o Discernment

o Mindfulness

o Inspiration



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Elders cannot

benefit from

counseling

Family members are

the best caregivers.

90 lb church ladies

don’t cuss. Someone in a wheel

chair can’t be

aggressive.

“Y’all just want to

drug people up”!

Medicare will pay for

placement.

“Old People” aren’t

sexual.ECT is not good for

the elderly.The doctor, nurse,

and therapist all

agree on how to

treat the patient.

Antipsychotics

should not be

used on dementia

patients.

“We can get Dad

back like he used to

be”.

“Mom can stay in the

hospital until her

room is ready at the

rest home”.

All older people have

memory problems.

The CT Scan is

normal, therefore

Dad does not have

dementia.

Administration on Aging:U.S. Department of Health and Human Services. (2009). Aging Statistics/Profile/2009/docs. Retrieved from aoa.gov:

http://www.aoa.gov/Aging_ Statistics/Profile/2009/docs/2009profile_ 508.pdf

American Foundation for Suicide Prevention. (2016). About Suicide:Suicide Statistics. Retrieved

from afsp.org: http://afsp.org/about-suicide/suicide-statistics/

Atik. (2015). Here are 10 Types of Dementia Based on Its Causes and Symptoms. Retrieved from

Infodiseases: http://infodiseases.com/here-are-10-types-of-dementia-based-on-its-causes-

and-symptoms.html

Centers for Disease Control and Prevention and Chronic Disease Directors. (2008). The State of Mental Health and Aging in America. Retrieved from cdc.gov/aging and:

http://www.cdc.gov/aging/pdf/mental_ health.pdf

Cress MSW, C. J. (2012). Handbook of Geriatric Care Management 3rd Edition. Sudbury MA: Jones

& Batlett Learning.

Department of Health and Human Services. (2016). MA-2270 Long Term Care Need and Budgeting.

Retrieved from info.dhhd.state.nc.us:

http://info.dhhs.state.nc.us/olm/manuals/dma/abd/man/


http://infodiseases.com/here-are-10-types-of-dementia-based-on-its-causes-

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Jassin M. Jouria, j. m. (2015). Aging and long term care: a complrehensive review. Retrieved from

ce4less: http://ce4less.com/Tests/Materials/E123Materials.pdf

Mary Bethel Pres, N. C. (2016, April 20). The Progressive Pulse. Retrieved from

pulse.ncpolicywatch.org: http://pulse.ncpolicywatch.org/2016/04/20/north-carolinas-older-

population-and-the-need-for-state-action-growing/

Masters, K. (2016, April 30). gun-suicides-mental-illness-statistics. Retrieved from thetrace.org:

https://www.thetrace.org/2015/11/gun-suicides-mental-illness-statistics/

Nava, J. (2014, July 24). old man throws down canes to dance (Turn Down For What).

Robert C. Atchley, A. S. (2004). Social Forces & Aging, an Introduction to Social Gerontology, 10th Edition. Belmont CA: Wadsworth/Thomson Learning.

The Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill. (2011).

shepcenter.unc.edu. Retrieved from shepcenter.unc.edu:

www.shepscenter.unc.edu/hp/prof2011.htm.

US Census Bureau. (2004). census.gov/prod/2004pubs. Retrieved from census.gov:

https://www.census.gov/prod/2004pubs/censr-19.pdf

World Health Organization. (2016, April). Mental Health and Older Adults. Retrieved from

www.who.int: http://www.who.int/mediacentre/factsheets/fs381/en/


Presenter: Janet H. Kanode, MSW, LCSW; [email protected]

Co-Presenters: Christy Adams, LRT, CTRS; [email protected]

Meredith Holladay, MA, LPC; [email protected] Jackson, MS, LPCA; [email protected]

Tammy Transou, MSW, LCSW; [email protected]

Collaborators: Karen Adams, MS LPC

Rob French, Community Relations

Jessica Gravley, LRT, CTRS (Kaleidoscope Design Engineer)

Leigh Stewart, Counseling Intern

Lauren Strickland, Recreational Therapy Intern

Novant Health Thomasville Medical Center

Geriatric Behavioral Health Unit StaffMelissa Colon, Program Director


http://pulse.ncpolicywatch.org/2016/04/20/north-carolinas-older-

mailto:[email protected]





THE BEHAVIORAL KALEIDOSCOPE OF GERIATRIC CARE: AN … · 2018. 4. 4. · Schizoaffective Disorder...

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