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2128 results in Geriatrics

Page 22 of 107

  • Chapter 5 - Problem-Solving Therapy

  • from Part 2 - Evidence-Based Psychotherapy in Later Life
  • Edited by Rajesh R. Tampi, Case Western Reserve University, Ohio, Brandon Yarns, Kristina F. Zdanys, University of Connecticut, Deena J. Tampi
  • Book:
    Psychotherapy in Later Life
    Published online:
    09 January 2020
    Print publication:
    16 January 2020, pp 75-91

  • Summary

    Problem-solving therapy (PST) is an evidence-based psychotherapy for depression, with particularly robust evidence for use among older adults. It is based on the premise that depression is maintained by ineffective problem-solving and resultant poor coping, low self-efficacy, and negative emotions. Problem-solving therapy aims to reduce symptomatology and maximize quality of life by developing problem-solving skills and emphasizing goal setting and action planning to achieve those goals. This chapter presents the theoretical framework of PST and reviews a typical course of treatment, illustrated by a case of an older depressed patient with cognitive impairment and complex biopsychosocial needs. Problem-solving therapy is a brief and effective intervention for older adults with depression, including those with concurrent medical problems. Recent empirical findings and considerations for special populations are presented, along with resources for further PST training.

  • Chapter 4 - Cognitive Behavioral Therapy in Late Life

  • from Part 2 - Evidence-Based Psychotherapy in Later Life
  • Edited by Rajesh R. Tampi, Case Western Reserve University, Ohio, Brandon Yarns, Kristina F. Zdanys, University of Connecticut, Deena J. Tampi
  • Book:
    Psychotherapy in Later Life
    Published online:
    09 January 2020
    Print publication:
    16 January 2020, pp 35-74

  • Summary

    This chapter introduces the research background and application of cognitive behavioral therapy (CBT) with older adults. First, an overview of the research literature is presented. Second, the theoretical framework underlying CBT is summarized with a focus on proposed agents of change. Third, research on patient selection, treatment modalities, and special topics is reviewed. Fourth, a session-by-session tutorial on the components of CBT from intake to treatment termination is provided. A case example is included along with several other cases to illustrate therapeutic techniques. Further readings, resources, and trainings are included at the end of the chapter.

  • Chapter 9 - Psychotherapy and Cognitive Disorders

  • from Part 3 - Special Topics in Psychotherapy in Later Life
  • Edited by Rajesh R. Tampi, Case Western Reserve University, Ohio, Brandon Yarns, Kristina F. Zdanys, University of Connecticut, Deena J. Tampi
  • Book:
    Psychotherapy in Later Life
    Published online:
    09 January 2020
    Print publication:
    16 January 2020, pp 139-149

  • Summary

    This chapter reviews the most researched psychotherapeutic interventions for individuals with cognitive impairment (CI) and common symptoms targeted by these interventions. Elements of assessment and psychotherapy modifications to consider when working with individuals with dementia are also discussed. Assessment components might include clarification of medical symptom overlap, collateral information, assessment instruments developed for individuals with cognitive difficulties, and incorporating consultation with other specialties. In general, clinicians should consider using simplified skills, increasing the number and frequency of sessions, shortening sessions, reducing group size, and providing more guidance during skill instruction and practice when working with individuals with cognitive impairments. Despite their promise and recommendations for their use, nonpharmacological therapies for individuals with dementia have a small research base and warrant continued development and evaluation.

Psychotherapy in Later Life
  • Edited by Rajesh R. Tampi, Brandon Yarns, Kristina F. Zdanys, Deena J. Tampi
  • Published online:
    09 January 2020
    Print publication:
    16 January 2020
  • Psychotherapy in Later Life is a practical how-to-guide for psychiatrists, psychologists and mental health workers on choosing and delivering evidence-based psychological therapies to older adults. It covers all the main evidence-based psychological therapies such as cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT), as well as specialist topics such as combining psychotherapy with pharmacological treatments, working with diverse populations and individual versus group therapy. The World Health Organization estimates that over the next four decades, the proportion of the world's older adults will nearly double, from twelve percent to twenty-two percent, and that one in five older adults has a diagnosable mental health disorder. Given the increasing number of older adults requiring mental health treatment, incorporating talking therapies into treatment plans is key to tackling issues related to polypharmacy, medication interactions and side effects. Written by experts in geriatric mental health, this book provides the most authoritative information on the use of psychotherapy in older adults.

  • 14 - Model Programs and Interventions for Older Adults with Schizophrenia

  • from Section 5 - Treatment and Services
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 169-189

  • Summary

    The burgeoning population of older adults with schizophrenia and other serious mental illnesses is on pace to overwhelm already-strained health care and long-term care systems in the U.S. Reducing premature institutionalization and excess risk of early mortality while enhancing community tenure among older adults with schizophrenia would not only help to mitigate the impact on various systems of care, but also satisfy the preferences of most older adults with schizophrenia. Many factors leading to premature institutionalization and death for these patients stem from co-occurring preventable chronic health conditions and modifiable health behaviors. In response to the health disparities facing this population, innovative model programs and interventions aiming to ameliorate health and wellbeing, while promoting community-living skills have emerged. In this chapter, we provide an overview of the research supporting current innovative model programs and three key approaches to addressing these challenges: illness self-management, psychosocial rehabilitation, and health promotion. Based on key strengths of the nine model programs and interventions detailed within, we offer novel strategies for future models with an emphasis on reach and sustainability at the population health level.

  • 18 - Schizophrenia in Later Life: Public Policy Issues in the United States

  • from Section 6 - Health Policy and Research: Future Directions
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 223-241

  • Summary

    This chapter recommends a broad range of public policy changes to promote increased life expectancy and quality of life among older adults with schizophrenia and other serious, long-term psychotic conditions. Needed changes include: (1) comprehensive efforts to reduce the mortality gap, (2) securing the future of the Social Security Trust Fund, (3) expanded community housing and non-institutional residential care, (4) expanded capacity to provide high-quality, integrated behavioral health and medical services, as well as recovery-oriented psychosocial interventions, (5) restructuring Medicaid and Medicare to assure funding is available for psychosocial interventions - especially housing, outreach and engagement, off-site services, rehabilitation, case management, and family support - as well as for traditional treatment interventions, (6) addressing problems of capacity and quality among service providers including the VA, (7) enhancing public education and anti-stigma campaigns, (8) addressing workforce inadequacies in both size and competence, (9) increasing and diversifying research to emphasize improving services and translating evidence-based practices into reality, and (10) enhancing coordination and geriatric mental health leadership of federal and state agencies and other systems that serve this population.

  • 19 - Epilogue: Controversies, Conjectures, and Future Directions

  • from Section 6 - Health Policy and Research: Future Directions
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 242-248

  • Summary

    This chapter discusses many of the key themes presented in this volume. Some of the principal issues include: (1) concerns about the diagnostic complexities of rendering a diagnosis of psychoses in later life and which outcome criteria should be used, (2) diagnostic challenges of new-onset psychotic disorders with respect to dementia, (3) the evolution and classification of cognitive disorders arising in older adults with schizophrenia (OAS), (4) factors influencing the diverse trajectories in the course and outcome of schizophrenia in later life, (5) the extent to which OAS show accelerated aging, (6) the lack of controlled studies in the use of antipsychotic agents in OAS and the potential for some persons to discontinue medication in later life, (7) the need for more controlled studies on non-pharmacological interventions in OAS, (8) the desirability for more qualitative studies of how OAS perceive their illness over their lifespan and how they view their current circumstances, (9) the recognition of the complementary roles for subjective and objective appraisals of daily needs and life quality, (10) the needs of caregivers of OAS, (11) the extent to which geographic differences influenced by national health systems and culture affect outcome and treatment strategies of OAS, (11) the elements comprising an individualized care model for OAS.

  • 9 - Positive Psychiatry for Schizophrenia and Other Psychotic Disorders

  • from Section 3 - Outcome and Course
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 112-116

  • Summary

    Positive psychiatry seeks to understand and promote well-being by assessing and enhancing positive psychosocial factors among individuals with or at risk for mental illnesses. This branch of psychiatry has roots in humanistic psychology and the positive psychology movement, but expands on them by focusing on the biology of positive traits and promoting well-being. Important positive psychosocial factors include resilience, optimism, social engagement, wisdom, post-traumatic growth, hope, and personal mastery. Contrary to traditional pessimistic views of schizophrenia, recent research has shown that patients often exhibit improved psychosocial functioning as they age. There is considerable variability in levels of positive psychosocial factors among individuals with schizophrenia, with some reporting levels of happiness, resilience, and optimism comparable to non-psychiatric individuals. Positive psychosocial factors are associated with biological markers of inflammation and insulin resistance, suggesting that their promotion may improve physical health too and, therefore, be promising intervention targets. Further investigations are needed to develop objective measures of positive psychosocial factors, explore biological processes underlying these factors, elucidate their longitudinal course, and offer pragmatic interventions to improve physical, mental, and cognitive health.

  • 17 - The Care of Older Adults with Schizophrenia in Developing Countries

  • from Section 5 - Treatment and Services
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 212-222

  • Summary

    The growing burden of schizophrenia in the geriatric population of the developing world is a complex and multi-faceted problem. While the underlying pathophysiology may be similar across patients, many challenges exist for the successful treatment and management of elderly schizophrenia patients in developing countries, including untreated medical comorbidities, culturally mediated barriers to care (e.g., stigma, preference for traditional systems of care), and lack of access to mental health resources and geriatric specialists. A number of promising healthcare delivery techniques can be implemented to reach isolated patients in the non-industrialized world. These include embedded outreach workers to bridge the divide between traditional beliefs and modern psychiatric care, thereby reducing stigma and skepticism towards allopathic medicine. Culturally sensitive ICT-based interventions appear to be promising methods of serving elderly schizophrenia patients with diminished access to care in emerging countries. It is evident that a comprehensive approach must be taken to characterize and appropriately meet the needs of older schizophrenia patients in the developing world, and to be efficacious, the evidence-based techniques applied must take into account local cultural sensitivities.

  • 15 - Changing Caregiver Needs with Increasing Age of People with Schizophrenia

  • from Section 5 - Treatment and Services
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 190-199

  • Summary

    With deinstitutionalization, family members, typically parents, have become providers of long-term home care for many patients with schizophrenia. However, caregivers age along with patients and are largely impotent in finding replacements. This chapter combines research findings and clinical reports from families describing home conditions and patient progress. Agreeable patients may be boons to aging parents. More typical are difficult patients who sometimes become angry and threatening , reject medication, and may require police interventions that usually lead to cursory crisis interventions that are countertherapeutic. In the U.S., familial replacement caregivers may be scarce. Research on elderly caregivers indicates little future planning and ignorance of resources. Many fear that patients will fight displacement from the family home and decompensate further. Research on siblings indicates willingness to supply social support, but many report hostility from patients. Research examples of cultural differences in caregiving, largely relate to family structure and available resources. Worldwide solutions and some national attempts to address aging caregiver loss among persons with disabilities are presented. Some helpful planning resources for U.S. caregivers are provided.

Page 22 of 107