Art in Elderly Facilities: A Weapon Against Mental Health Issues

A study published in PubMed (public medicine.gov) seems to conclude that so-called "art therapy" is extremely conducive to prolonged stable mental health in older individuals who reside in nursing homes.  Art seems to not only improve general disposition and mood but also helps elders who are beginning to struggle with fine motor skills.  When one is focused and invested in something, they are seemingly less likely to enter into a state of depression or become anxious about their situation.  The authors praise the art programs in nursing homes but do admit that it would be very difficult to integrate such programs into all nursing homes.  It is expensive and requires a full time commitment from at least one art instructor.  The authors also present the idea that residents can find valuable forms of self expression through artistic endeavors.  Being able to blow off steam or other negative emotions via art is a healthy release that promotes well being and also allows the resident in question to formally acknowledge whatever it is they're are struggling with inside.  For residents that are severely impaired or unable to engage in communication, art can serve as just that, a way of talking with the world around them and expressing themselves in the process.

http://www.ncbi.nlm.nih.gov/pubmed/10114781

What Would it Cost to Integrate Mental Health Services into Elderly Homes?

In 1987 the Nursing Home Reform act was passed, making it legally mandatory that all nursing homes provide basic mental health services for all registered residents.  In 1993, three PhD authors published an article in The Journal of Mental Health Administration.  The authors discuss what particular services should be added to nursing homes and how expensive it would be to make such additions.  The authors argue that one of the more affordable methodologies towards administering mental health assistance is via the use of group psychotherapy.  This would allow groups of residents to receive treatment, all at one time, thus cutting down on expense.  Regardless of such methodologies, the authors still conclude that adding true mental health services to nursing homes would be extremely expensive.  Despite the legality of having to provide basic mental health services, nursing homes could still greatly benefit from a full on mental health support system.  The authors consistently stress that more money should be directed towards creating a screening process in each and every registered nursing home in the country.  Such a process could help to identify patients with mental illnesses or those prone to becoming depressed, anxious, etc.  It seems to me that prevention is the best weapon against mental health disorders.  Knowing when someone is likely to have a mental break or be prone to suicidal behavior puts staff and workers on alert.  Psychotropic drugs and an onboard psychiatrist would also be a lot better than just over-doping troubled patients with generic medications.



http://link.springer.com/article/10.1007%2FBF02518691#page-1

Moving in An Elderly Family Member

When discussing mental health and nursing homes, it is quite often that the subject is discussed within the parameters of behavior inside the walls of the nursing home.  But what about mental health issues in relation to prospective residents who are not sure if they are interested in the nursing home community?  What about residents who are essentially being forced to enter into a nursing facility because their family can no longer take care of them at home?  The mental health of these individuals both before and during the move in period should be analyzed, studied, and hopefully understood.  The mental well being of the child or family member that is forced to make the "nursing home decision" should also be taken into account.  It is an extremely difficult thing to send away someone you love because you know their health is ailing and that you can no longer afford to take care of them personally.  Stella Henry, author of The Eldercare Handbook, suggests opening the lines of communication with a family member far before making the final decision.  Henry warns that a quick and hasty decision to move a family member into a nursing homes is often especially difficult for the new resident.  The trick is to warm the water slowly.  It seems that a careless and unplanned decision to put an elder into a nursing home can result in family chaos and the chance of high levels of anxiety or even depression for both the new resident and other members of the family.  Barry Jacobs, a psychologist who specializes in nursing home mental health, suggests confining a parent or family member to simply visit a facility prior to actually attempting to convince them to live in one.  Jacobs argues that there are no "shortcuts" or "tricks" to convincing a family member to live in a nursing home, in fact heading down that route only yields problems.  It is best to be sincere, honest, and as non-pushy as possible.  

A Place for Mom, 25 Apr. 2014. Web.  28 Apr. 2014. <http://www.aplaceformom.com/senior-care-   resources/articles/moving-elderly-parents>

Attached is a YouTube video in regards to moving in a parent/family member that has Dementia or Alzheimer's disease.  

Suicide in Elder Facilities

Suicide statistics rank the highest with members of the elderly population.  Many contributing factors lend themselves to such a spike in suicidal tendency.  As an individual ages, the chances of mental or physical impairment increase.  An individual who has become severly handicapped by a worsening state of health is likely to become depressed and can potentially reach a point where he/she views suicide as an out.  Even up till today, very little has been published regarding suicide and suicide prevention in elderly nursing facilities.  However, a study was performed and released back in 2000 that was featured in The Journal of the American Medical Directors Association.  A populate based, retrospective cohort study was performed in order to ascertain the clinical features of nursing home residents that were likely to commit suicide.  The goal of the study was to learn how to identify behavioral patterns that would indicate suicidal ideation in an elderly resident.   The study identified that the most likely avenue for suicide in a nursing home is via overdosing of prescribed medication (painkillers, etc.).  The study also concluded that suicide risk in nursing homes is likely under-reported and under accessed.  It is important to note that method of suicide also differs based on what is available to the resident.  For example, a wheel chair bound resident will not have the same access to sharp objects that a mobilized resident has.


Works Cited

Evans, JM, Menghini, VV.  "Suicide Among Nursing Home Residents: A Population-Based Study."  The Journal of the American Medical Directors Association.  Mar-Apr.  2000: 47-50.  Print.

Aggression in Elderly Schizophrenic Patients

A common complaint by nursing home staff is that elderly mentally ill patients are often verbally and sometimes even physically aggressive.  It is important to understand that mental diseases such as Schizophrenia and Alzheimer's are incredibly frustrating for the patient, and unfortunately degenerative.  Often, treated patients understand their predicament and are forced to live everyday knowing their minds are being taken over by a mysterious disease.  This can incite aggression, anger, and mood irritability.  Unfortunately, sometimes physical violence is a result of this.  Nursing home staff are often trained on how to deal with a physically aggressive resident.  However, the nursing home industry has a reputation for over dosing highly aggressive patients.  While maintaing the safety of nursing home staff is extremely important, so is the overall well-being of residents.  As mentioned in previous posts, over dosing a patient can be an extremely dangerous and reckless method of pacification.  There are far too many health and dependency risks associated with over dosing.

The Department of Psychology at Hofstra University in Hempsted conducted a research study to see if elderly mentally ill patients had a higher chance of exhibiting violence or aggression than younger afflicted patients.  Patients were assessed with a neuropsychological battery of tests and gauged for violence, aggression, and irritability of mood.  The findings revealed that elderly patients are at the same risk for exhibiting violence/aggression as younger patients.  This means, that according to this study, there is no correlation between age and aggression among  mentally ill patients.  The chance of violence or outbursts of anger remains the same for all mentally ill patients.  As symptoms worsen, the likelihood of violence or aggression becomes significantly more prominent, but age does not correlate.

Attached is an interesting video on how to handle aggression in elderly patients.  

How Best to Approach Mental Health Care in Nursing Homes

Unfortunately, nursing homes do not have the best reputations for dealing with mental health issues.  Taking care of elderly individuals and running a full service nursing home is already a massive and difficult undertaking.  Managing elderly residents who have special needs due to mental health disorders makes things even more complex.  Medically treating a mentally ill patient is the work of a psychiatrist, a doctor who specializes in treating mental health issues via the use of prescription medication.  Finding and maintaining the right dose and the right medication for a particular patient is an art form, and sometimes it can take a bit of experimentation before the right drug and the appropriate amount actually makes a positive difference in the patient's life.  Nursing homes often do have onboard psychiatrists, but no one individual can constantly manage every patients' doses at the same time.  Thus, many nursing homes have developed a reputation for over doping their special needs patients in order to make them more docile.  This is a dangerous and highly inappropriate approach to medical treatment.  Over doping patients can result in medical complications and may even promote drug dependency issues.  Dr. Eleanor Feldman Barbera, PhD, is the author of The Savvy Resident's Guide and has over 17 years of experience as a psychologist in long-term care.  She maintains a medically oriented blog that focuses primarily on nursing homes.  I arrived at some interesting facts while reading through her work.  For one, it seems that younger people now account for 10% of the nation's 1.4 million nursing home residents.  Secondly, and perhaps most interestingly, Dr. Barbera suggests utilizing a set of steps for making sure a loved one who is about to enter the mental health unit of a nursing home, receives the most appropriate care.

1. Collect as much information as possible in regards to the patient at hand.  (Which medications have worked in the past, and at which doses.  Medical history, medical allergies, behavioral patterns, etc.)

2. Immediately upon admission to the mental health unit of the nursing home in question, make sure the patient becomes acquainted with the onboard psychiatrist/psychologist.  It is important for the individual in question to quickly establish a health relationship with her health provider.  If the relationship is unsavory or trust is not built, an external psychiatrist should be brought in who can better serve the patient's needs.

3. Make sure that the staff who will primarily work with the resident in question are well briefed in regards to his/her condition.  Knowing what medications to use and at what doses is VERY important when it comes to the treatment of mentally ill individuals.  It is also crucial that the staff of the nursing home be well versed when it comes to reading the patient's mood swings and understanding his/her behavioral patterns.

4. Make sure the family of the patient in question is involved in the admission process.  Family members are typically the best people to talk to about previous experiences, behavior, and the success or failure of certain medications in the past.



Works Cited

"Helping Mentally Ill Nursing Home Residents." mybetternursinghome.  Web Marketing Magician, n.d. Web.  24 Apr. 2014.

Selected Methodology for Ethnographic Work at the Jewish Home of San Francisco

After much debate, I have come to the conclusion that "co-performance"/ "deep hanging out" is ultimately the most suited form of approach for our work at The Jewish Home of San Francisco.  Volunteering at the Jewish Home is all about social and communicative interaction with the residents of the home.  Even the regular volunteers, who have no ethnographic agenda, are expected to actively participate within the community and to socially engage the residents.  Thus, the ability to truly immerse ourselves within the community and quite simply "hang out" with the residents is crucial to our ultimate understanding of how this particular community operates/functions.  "Co-performance" and "deep hanging out" are well known ethnographic concepts, first pioneered by Dwight D. Conquergood.  What particularly attracts me to Conquergood's methodology is his emphasis on listening while engaging with the community at hand.  Conquergood stresses that as researchers, we must learn to forgo our visual sight and instead focus more on listening to those around us (the subjects of the study).  As Madison so elegantly puts it, "listening invites dialogue" (p. 184).  Beyond this methodology, I also belie

ve that Geertz's use of "thick description" could potentially serve us well.  Our ability to write down, in the most descriptive way possible, our findings and impressions is crucial to our research.  Prior to beginning the "thick description" process, each member of our group will do his/her best to acknowledge and mark their positionality (biases, previous experiences, beliefs, prejudices, etc).  


Works Cited

Madison, D. Soyini.  Critical Ethnography: Method, Ethics, and Performance.  Los Angeles, London, New Delhi, Singapore, Washington DC: SAGE Publication, Inc., 2012.