The Challenge of Geriatric Care
Zarit, Steven H., Clinical Psychiatry News
This should be a golden age for geriatric mental health care.
Medicare pays for psychotherapy and other mental health services. There's been a gradual growth in empiric-based evidence for the effectiveness of psychotherapy, including evidence that it works in older people.
New generations of medications provide new opportunities for treatment, and combination therapies show promise. The topic of aging is on the political scene.
So why don't things feel so golden?
The public care system is breaking down. There's little integration of mental health and aging networks, with a few exceptions. We've become overreliant on medications.
Nursing homes serve as today's chronic mental hospitals. There are critical shortages of people trained in geriatrics in all mental health professions.
Several promising developments give me hope, however, and deserve close attention.
The Primary Care Model
Recent studies, including the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT), have explored new models of integrating mental health care in primary care practices.
Currently, depression goes unrecognized in 16% of patients aged 60 years and over who are seen in primary care practices.
The study results suggest that giving primary care physicians support staff and tools to better recognize and treat depression can help older people who feel greater stigma about going to see mental health specialists.
Another positive example is a partnership between the Alzheimer's Association and Kaiser Permanente in Cleveland to improve managed care of dementia. Diagnostic guidelines and protocols improved recognition of dementia, and multicomponent care consultations improved outcomes.
Psychotherapy as a Core Skill
With older people, there is a greater awareness that psychotherapy has a place not only in one-on-one sessions in a counselor's office, but as a useful component in geriatric assessments, case management, nursing home consultations, combination therapy with medications, and management of medication side effects or the emotional changes that accompany illness and/or healing.
Geriatric-informed psychotherapy has evolved in ways that better fit older patients by dealing with comorbidities, providing greater roles for the patient's family in interventions, and recognizing that maintenance, not cure, may be the focus of treatment for some of these patients.
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