PSYCHOLOGY AND LONG TERM CARE

(Re-Printed From The California Psychologist)

There is a great need for mental health interventions and psychologists with geriatric training in nursing homes. At any point in time, approximately 5 percent of the population aged 65 and over are institutionalized. Among nursing home Residents, there is a high incidence of psychological problems. According to the 1985 National Nursing Home Survey, 43 percent of nursing home Residents were admitted with diagnosed psychiatric disorders, including organic brain disorders, psychoses, depression, anxiety and personality disorders. It is likely that these statistics under represent the prevalence of psychological disturbance found in nursing homes.

Psychologists working in long term care (LTC) can have a significant impact on improving the quality of life of nursing home Residents. When working in LTC, clinicians must first come to terms with their own attitudes about aging and the elderly, including the belief that older people are incapable of change. As psychologists working in nursing homes, we have found that geriatric LTC Residents can change and we have repeatedly witnessed the positive impact of psychological interventions on both Residents and staff. This article will describe the role of psychologists working in LTC by examining the areas of assessment, therapeutic intervention and staff consultation.

Assessment

A unique contribution of psychologists in LTC, is the systematic approach to assessment of cognition, affect and behavior. Assessment of nursing home Residents requires a bio-psychosocial approach to assessment due to the high incidence of comorbidity of medical and psychological problems in this population. Geriatric assessments often include evaluations of cognitive status, emotional functioning, ability to perform activities of daily living (ALD's) and behavioral problems. A challenge for psychologists working in LTC is finding assessment measures appropriate for frail institutionalized elders. Standard measures often lack age-appropriate norms. Administration of traditional instruments is often further complicated by Residents' sensory deficits, physical disabilities and cognitive deficits. Psychologists must be creative in finding other sources of information aside from formal assessments, such as clinical interviews with the Resident, behavioral observations and ancillary sources such as family, friends and staff.

Therapeutic Intervention

Various psychotherapeutic modalities have been used successfully with nursing home Residents including individual, marital, family, group and milieu. Because of the heterogeneous nature of the elderly and their problems, a variety of therapeutic orientation have been used in LTC, including insight-oriented, interpersonal, cognitive-behavioral, existential, system supportive, pet facilitated and reminiscence. Common issues addressed in therapy include loss, role changes, existential issues (re-establishing a sense of meaning in life), loneliness, fears of becoming more disabled and dependent, family conflicts, Resident-staff conflicts and depression. Behavioral problems including agitation as well as verbal and physical aggression have also been the focus of psychological interventions. Behavioral medicine techniques can be useful with LTC Residents to address chronic pain, sexual dysfunction, tension, sleep problems, smoking, eating disorders and living with chronic illness. Because the Resident lives in a social context and interacts with different Resident's and staff members, it is important for the psychologist to be integrated into the treatment team. Keeping the lines of communication open among LTC staff facilitates the success of therapeutic interventions by promoting a consistent treatment plan.

Consultation To Staff

A third area of practice for psychologists working within long-term care institutions is staff consultation. Psychologists can offer a unique perspective toward improving patient-staff interactions in LTC settings, thereby increasing the "Quality of Life" for geriatric Residents and work satisfaction for LTC staff. Psychologists working in LTC settings are often requested to help staff address problematic resident behavior, such as medical noncompliance, yelling or physical combativeness. Psychologists can be key in helping LTC staff identify and modify the complex web of bio-psychosocial factors, including staff response to Resident behavior that contributes to the undesired behavior's occurrence.

Staff consultation by psychologists can also involve educating staff about psychiatric disorders, such as the dementia’s, depressions and schizophrenia that commonly occur in geriatric LTC Residents. Providing staff with information about the behavioral symptoms associated with these disorders, possible etiological factors and intervention strategies, helps staff interpret and respond more appropriately to disorder associated behaviors. Psychologists can assist staff in improving inter-staff communications, which in turn can result in more productive team functioning and greater job satisfaction for LTC staff.

Summary

Psychologists in LTC meet the challenge of working with frail elders who often suffer from both psychological and medical problems. In our aging society, the need in LTC for psychologists with geriatric training will certainly increase. Psychologists use assessment techniques, therapeutic intervention and staff consultation in attempting to improve the "Quality of Life" of LTC residents. Working as a treatment team member, a psychologist can become a valued resource for improving staff understanding and treatment of the residents.

Note

"Psychology and Long-Term Care" was written by Margaret Florsheim, Ph.D. and Laura Peters-Katz, Ph.D. and published in "The California Psychologist". We have enclosed this for your perusal and to assist us in disseminating our message. If you feel that a cost-free service which provides psychological interventions, care planning, staff training and In-Services, assistance with OBRA guidelines and also assists you in maintaining a high standard for the "Quality of Life" of your Residents is worthy of consideration, please take a moment to call us at 1-800-424-2686.