Lesson 1: Conceptual Foundations of Geriatric Mental Health
Attention
This course is not only about mental health problems, but about mental HEALTH...we will be exploring some of the challenges of getting older, but we will also explore the opportunity for Positive Aging!
Learning Outcomes
Upon completion of this lesson's material, students will be able to:
- Identify the potential emerging roles for mental health technicians in geriatric care
- Discuss personal perceptions and experiences in relation to geriatric care and mental health
Teaching
Challenges
- Medical care system is the de facto mental health care system for the elderly
- Lack of understanding of geriatric mental health issues
- It needs to be more than diagnosis and treatment---it impacts successful aging
- This population is growing
- Multiple doctors, prescriptions, without communication
- Over 65 is the highest incidence of suicide
Bittersweet Success of Aging
- People are living longer, healthier, and more productive
- Increased likelihood of chronic illness, functional impairments, frailty, and changes in quality of life
Review the slideshow below about the future of geriatric mental health care.
Mental Disorders and Aging: An Emerging Public Health Crisis in the New Millennium?
Based on the information in the slideshow:
- What emerging roles do you see for the MHRT/C?
- What personal experience do you have of any one of these issues?
Models of Care
- Medical model
The traditional approach to the diagnosis and treatment of illness as practiced by physicians in the Western world since the time of Koch and Pasteur. The physician focuses on the defect, or dysfunction, within the patient, using a problem-solving approach. The medical history, physical examination, and diagnostic tests provide the basis for the identification and treatment of a specific illness. The medical model is thus focused on the physical and biological aspects of specific diseases and conditions. Nursing differs from the medical model in that the patient is perceived primarily as a person relating to the environment holistically; nursing care is formulated on the basis of a holistic nursing assessment of all dimensions of the person (physical, emotional, mental, and spiritual) that assumes multiple causes for the problems experienced by the patient. Nursing care then focuses on all dimensions, not just physical. (Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier.)
- Functional model - This model looks at the underlying causes of medical conditions not just the outward signs.
- Rehabilitation model
Rehabilitation is one of the basic elements of comprehensive geriatric care. Rehabilitation is indicated when someone is not functioning at their full potential. It involves an assessment of the underlying causes of activity limitation, treatment of the primary impairment to the extent possible, prevention of further disability, and interventions to promote adaptation of the person to their disability. The goal of geriatric rehabilitation is to maximize functional independence. Rehabilitation in general, and geriatric rehabilitation in particular, is provided by an interdisciplinary team. The basic team consists of one (or more) occupational therapist, physiotherapist, physician, rehabilitation nurse, and social worker. Other disciplines that can be involved either as part of the core team, or on a consultation basis, include dietetics, pharmacy, psychology, recreational therapy, or speech-language pathology. A team that works well together, and whose members have an understanding of and respect for each other’s contributions and strengths, is integral to a successful rehabilitation program. (Encyclopedia of Aging | 2002 | Freter, Susan © 2002 The Gale Group Inc.)
- Developmental Perspective
The Developmental Perspective In this course we are essentially discussing how humans change over time. We examine this issue from a multitude of perspectives, but overall, we are concerned with, and we are informed in our investigations by taking the Developmental Perspective or "DP". The DP is very simple. When we are faced with a question in psychology we affirm that the answer to that question may very well be impacted by how OLD the person is. In this class we will be studying what NORMALLY happens across the lifespan and based on that knowledge we can take the DP on any topic. Here are some examples: "How does divorce effect the children?" This is obviously a great question, but for this class it is incomplete. Before we can really answer this question we need to know how old the kids are. We know that changes in family structure can have profound impacts on an individual but these impacts will be different based on how old the person is. Let's say the person we are asking this about is 10 years old. What is "normally" going on in the life of a 10-year old that may be impacted by a divorce? What if the person we are asking this about is 17? What if they are 25? What if they are 50? (Remember, a divorce can happen at any time in the lifespan). It should be apparent to you now that it is quite difficult to answer a question without asking how old the person is. Note: Taking the DP is not the same as applying Developmental Theory. You are NOT taking the DP when you ask something like "How does intelligence change over childhood?" or if you ask "How does memory change in late adulthood?" These are simply applications of theory and knowledge. The DP adds age to the equation of a question that is not about age (to begin with). So we ask questions like these:
|
Concepts and Principles on Aging
- Aging is not just about old age, it is a natural process occurring across the lifespan
- Aging is more than the number of years the person has lived (biopsychosocial perspective)
- Aging is not a disease or a disorder
- Ageism has a destructive influence on geriatric health and mental health care
- Normal aging and pathological aging are interrelated and complex
- Successful aging is a concept invoked to describe older persons who live long, happy, and vital lives
- Why people age is not well understood
- Drawing a sharp distinction between physical and mental health is artificial and antiquated
- Mental health is more than the absence of illness
- The DSM needs revision to better describe geriatric mental health
- Feelings and behaviors (used to construct diagnoses) are subject to individual culture, perceptions, and beliefs
- Clinician's attitudes effect their practice
- History is key to diagnosis and treatment
- The person's experience of illness is important (What does this mean to YOU?)
- Social etiquette is important when communicating with the elderly
- Drug treatment has to be approached with special care
- Health promotion and risk prevention are important
- Older persons are at risk for serious negative outcomes
These problems are daunting but they present opportunities.
Assessment
Lesson 1 Discussion (for online class only)
Select and identify one of the "Concepts and Principles" listed in the Lesson. Outline your perspective on the concept and share a personal experience that supports your perspective.
Lesson 1 Quiz
- What emerging roles do you see for the MHRT/C in light of the information in this lesson?