Pathways for Aging

One of the benefits to teaching at a university is access to the volumes of research in the Library.  One day, while researching articles for the class I teach, I came up on an interesting article, Value of Interpersonal Therapy in Older Adults with Different IPT Foci, in the Jan-Feb 2003 volume of the American Journal of Geriatric Psychiatry. 

 At WUSTL we are placing increasing emphasis on evidence-based practice, and this article caught my attention, as the researchers examined recurrence rates of major depression in older adults regarding the focus of treatment.  The results of the study showed that clients whose treatment focused on role conflict(usually marital conflict), did much better with ongoing maintenance psychotherapy versus those who received medication only.

 Just a few weeks ago, the therapists of Pathways  for Aging, were discussing issues in termination with clients.  We find that while most clients are treated and discharged successfully, some clients need longterm support, particularly those with limited family support.  Older adults have often lost the family and community support they had in the past, and physical and mental impairments impact their ability to  interact with others and develop new supports.   The therapist must evaluate each client individually and work together with that client to determine what is the best course of action for them.

 We invite your comments and opinions on the value of psychotherapy with older adults suffering from Depression.

I wrote in December’s eNewsletter about how those Home for the Holidays visits can bring some surprises, when you see signs & symptoms of dementia and/or depression, which may be of concern, when you visit elderly family members at the holidays.  Today I found an interesting blog which also noted how January is a time for professionals and organizations serving older adults.  The blog includes some good tips of where to begin - Mothering Mother.  Check it out and see if you find it helpful.

Times are changing…………! In October I wrote a post about Women as Caregivers and asked readers for comments.  While women still tend to be the predominant caregivers, today, I ran across a great article about the increasing numbers of men who are caregivers in My Elder Advocate.  In the article by Jack Halpern, he says

 ”…. with smaller families and more women working full-time, many men have no choice but to take on roles that would have been alien to their fathers.  Just as   fatherhood became more hands-on in the baby boom generation, so has the role for many sons as their generation’s parents age.”

He goes on to describe some of the special challenges men face and the reactions they receive from others.  Click on the link above link to see more of what he has to say.  We would love to hear some of your comments and experiences.

Last week, Work Place Options (WPO) posted a report on the survey they conducted of employers offering assistance with caregiving for the elderly.  They found that “Concern for older family members is increasing along with the aging population, and making informed decisions about elder care can be very stressful and time-consuming. Finding appropriate, quality care for aging family members is a paramount concern for many working adults, and worrying about this major decision can take a heavy toll on work-life balance”.

Some employers of adult children have paid for in-home assessments and recommendations from a geriatric care manager to assist them with caregiving of an elderly family member.  Does your employer offer this benefit?  If not, why not ask if this is something which can be made available?  It could help you and your loved one to make decisions that are best for your family.  To read the entire article you can go to dBusinessNews.com

What do you think?  Though I hear from both men and women caregivers, I hear from more women than men.  Is this societal, genetic, or accidental?  Apparently, others have considered this question; I found this Blog Post on The Caregiver Blog, written by a female caregiver: http://opentohopecaregivers.com/caregiver/uncategorized/does-caregiving-affect-women-differently/  Check it out and let us know what you think…….

I just returned from the annual state conference for the Missouri Association of Homes for the Aging (MoAHA) at the Lake of the Ozarks.  I was honored to be invited as a guest speaker on the topic of Decisional Capacity - how to determine when someone is too incapacitated to be able to make their own decisions.  This is a topic that often arises with older adults and people with disabilities.  It is often difficult because it is subjective, and we vascillate between wanting to preserve the automony of older adults and protect them from harm. 

I invite your comments on how you determine this and weigh the risks vs. benefits of these type of decisions. 

I just found this recent report on the website of the National Institute of Mental Health (NIMH), Science Update section, which promotes preventive treatment of Depression, through medications or psychotherapy (talk therapy):

“For the first time, researchers show that preventive treatment with an antidepressant medication or talk therapy can significantly reduce the risk or delay the start of depression following an acute stroke, according to a study funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. These findings differ from past studies attempting to prevent poststroke depression. The study appears in the May 28, 2008, issue of the Journal of the American Medical Association.

“Post stroke depression can impede rehabilitation and recovery of functional skills, reduce quality of life, and may also shorten a person’s lifespan,” notes NIMH Director Thomas R. Insel, MD. “Thus, early detection and intervention, in addition to preventive methods, are important components of post stroke treatment.”

Robert G. Robinson, M.D., of the University of Iowa, and colleagues compared the effects of the antidepressant medication escitalopram (Lexapro) with placebo (sugar pill) in 117 adults, ages 50-90, who had suffered an acute stroke within the previous three months. Neither the participants nor the researchers knew who was receiving the medication or a placebo during the study. Another group of 59 adults were randomly selected to receive Problem Solving Therapy (PST), a talk therapy that helps people identify problems that interfere with daily living and contribute to depressive symptoms and then develop strategies to solve those problems. None of the participants had depression at the start of the study.

The researchers tested escitalopram because previous research had shown that it worked quickly and effectively and could be tolerated over the 12-month study period. They chose PST over other forms of talk therapy because it was developed for use in older people.

People who received either escitalopram or PST were less likely to develop depression (8.5 percent and 11.9 percent, respectively) than those who received the placebo (22.4 percent). 

This is the first study of its kind to show some cases of post stroke depression can be prevented with intervention. In addition to the need for further studies, greater attention needs to be given to improving the early detection of and interventions for depression during standard stroke care, the researchers say.

Reference

Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, Fonzetti P, Hegel M, Arndt S. Escitalopram and problem solving therapy for prevention of poststroke depression: A randomized trial. JAMA. 2008 May 28;299(20):2391-2400.

I just read an article in Aging Well and have seen a few articles on-line about the benefits of a “Financial Life Plan”.  As the following article excerpt from Goliath Business Knowledge on Demand, explains:

 ”Some [financial]planners especially with regard to retirement planning, are taking a so-called “holistic approach” to counseling clients. A great deal of time may be spent exploring the individual’s lifestyle, what makes them happy, and how they picture the “perfect” retirement”.

Collaboration between various professionals in the aging field, such as financial planners, social workers, elder care specialists, etc., can help an older adult and family to look at their particular needs and situation in a truly holistic manner.   In addition to evaluating finances, this includes looking at goals, life expectancy, quality of life, residence, etc.

Consider including an assessment or consultation with a geriatric care manager at Pathways for Aging,  when making your financial and estate plans.

July 28: For seniors dealing with Alzheimer’s disease, keeping busy can make the difference between moving into a nursing home and living at home with a spouse. NBC Chief Medical Correspondent Robert Bazell reports in the first of a two-part series.  This report was on tonight’s evening news & can be viewed on-line at http://www.msnbc.msn.com/id/25888757/    The report emphasizes the benefits of exercise - both physical & mental in slowing down this disease process.

Depression can play a major role in a person’s ability to stay active.  If your loved one is having difficulty following this advice, consider whether treatment for Depression, may help their ability to lead a healthy lifestyle, and decrease the impact of this disease.

“Life can only be understood backwards” said 19th century Danish philosopher, Soren Kierkegaard.

The clinical social workers at Pathways for Aging, often use Life Review as part of our treatment plan, for older adults suffering from Depression and loss of Self-Esteem. Aiding them in gaining perspective on their lives as a whole and the achievements they have made, can be a powerful tool.

Becky Fierberg, MSW, LCSW, one of our clinical social workers, is writing an article, which further spells this out for our July eNewsletter. I hope you will take the time to learn more about life review and the benefits it can offer.