the behavioral kaleidoscope of geriatric care: an … · 2018. 4. 4. · schizoaffective disorder...
TRANSCRIPT
5/6/2016
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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
Novant Health/NASW-NC Clinical Institute 2016
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
Novant Health/NASW-NC Clinical Institute 2016
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)
Novant Health/NASW-NC Clinical Institute 2016
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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
Novant Health/NASW-NC Clinical Institute 2016
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
Novant Health/NASW-NC Clinical Institute 2016
• 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
Novant Health/NASW-NC Clinical Institute 2016
Novant Health/NASW-NC Clinical Institute 2016
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https://https://www.youtube.com/watch?v=pM_ zoqjUL38
Novant Health/NASW-NC Clinical Institute 2016
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.
Novant Health/NASW-NC Clinical Institute 2016
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.
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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
Novant Health/NASW-NC Clinical Institute 2016
Repeat “Customer”
Learned Helplessness
Developing appropriate aftercare plan in light of an
abusive home environment
Novant Health/NASW-NC Clinical Institute 2016
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
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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
Novant Health/NASW-NC Clinical Institute 2016
• 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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Novant Health/NASW-NC Clinical Institute 2016
• Art
• Therapeutic Drumming
• Tai Chi
• Wellness Garden
• Spirituality
• Pet Therapy
Novant Health/NASW-NC Clinical Institute 2016
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
Novant Health/NASW-NC Clinical Institute 2016
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
Novant Health/NASW-NC Clinical Institute 2016
Novant Health/NASW-NC Clinical Institute 2016
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Novant Health/NASW-NC Clinical Institute 2016
Novant Health/NASW-NC Clinical Institute 2016
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/
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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/
Novant Health/NASW-NC Clinical Institute 2016
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
Novant Health/NASW-NC Clinical Institute 2016