Psychologists Propose Integrated-Care Model for Elders

Aging Today, May/June 2008 | Go to article overview

Psychologists Propose Integrated-Care Model for Elders


"Mrs. Garcia's primary care physician may have assumed that because of her age, disability associated with her diabetes was to be expected arid that interventions to increase her ability to manage her medications would be ineffective. Mrs. Ruttger's neurologist disengaged once the diagnosis of a progressive neurodegenerative disease was made, and he withdrew from the process of improving her quality of life and that of her caregivers when he determined there was 'no hope, no cure.'

"Perhaps the assumption that older people are physically and mentally frail underlies the persistent deemphasis on prevention of disability that is exacerbated by the structural and financial underpinnings of our healthcare system."

These examples of ageism by medical practitioners are quoted from Blueprint for Change: Achieving Integrated Health Care for an Aging Population, a report issued recently by a distinguished task force of the American Psychological Association (APA). The document will be the focus of a major symposium at APA's 116th annual convention in Boston, Aug. 14-17.

ESSENTIAL MODEL

"Developing a model of integrated healthcare is essential as the U.S. population ages, and mental health care providers can make unique and critical contributions to this paradigm," the report states. The document proposes a basic model for interdisciplinary healthcare that includes providers in a range of healthcare professions who should be represented on any eldercare team, such as physicians, psychologists, nurses, physical therapists, pharmacists and social workers.

According to the authors, "In an interdisciplinary team, no one person is designated as 'the leader,' although one person might function as an administrative coordinator." The task force explains that such teams "are characterized by shared leadership and shared power in decision making across all the professions involved in the team." The Blueprint adds that such teams have long been used by the U.S. Department of Veterans Affairs and in many long-term care settings or geriatric primary care sites.

"As members of an integrated healthcare team, psychologists are encouraged to offer consultation to family members, significant other close relations and to other professionals," the task force emphasizes. In particular, says the report, psychologists can contribute an understanding of aging and adult development and can clarify which clinical problems might be reversible, such as those caused by other treatments or medications. Also, they can assess mood or anxiety disorders, psychosis and suicidal symptoms, among other mental health issues, as well as address behavioral medicine issues, such as insomnia, pain or difficulties adhering to medical treatment.

The Blueprint specifically notes that the contributions of geropsychologists, health psychologists, neuropsychologists and others trained in behavioral medicine "will be particularly welcomed among integrated healthcare teams."

The Blueprint was developed as an initiative of Indiana University psychologist Sharon Stephens Brehm, APA's 2007 president. Initiative cochairs were University of Michigan psychologist Toni C. Antonucci and Antoinette M. Zeiss, of the Department of Veterans Affairs in Washington, D.C. The report outlines the challenges and benefits of building interdisciplinary teams to address the specific healthcare needs of older people, "particularly as the baby boom generation ages," the task force notes. …

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