Geriatric mental health essential for sustaining quality of life.
For the past five years, Jason Charland has been a direct care provider in a group home for adults with mental illness, assisting residents with daily living tasks and recreational activities, supporting social skill development and administering medications. The experience prompted him to pursue a master’s degree in social work at the University of Maine.
“What I really understood is the impact you can have on an individual’s quality of life,” he says. “Providing interaction and support is very rewarding.”
In the Master of Social Work (MSW) Program, Charland has worked as a field student, then as a graduate research assistant in UMaine’s Center on Aging. He has been involved in varied Center on Aging projects, including researching the transportation needs of elders with chronic illness, elder abuse screening and education in the primary care setting, and prescription drug conference planning.
Charland’s full-time job as a direct care provider also gave him a unique perspective on a research project designed to improve services for the elderly with mental health issues in the state. He developed a training program on geriatric mental health for direct care providers and compiled information on elder suicide prevention for the Maine Joint Advisory Committee on Select Services for Older Persons, and the Maine Department of Health and Human Services.
The joint advisory committee and the department were charged by the legislature with addressing issues in a law passed in 2005 to improve access and delivery of mental health services to older adults.
Charland developed a five-hour training curriculum for direct care service providers working with Maine’s older adults in long-term care, residential and home care settings. The educational program covers aging myths and keys to healthy aging, late-life depression and elder suicide risk, Alzheimer’s disease and dementia, other mental illnesses, management of difficult behaviors and substance abuse.
“All older adults have unique needs,” Charland says. “Becoming aware of those needs when it comes to mental health will help the quality of services direct care workers provide.”
The effects of chronic illness, multiple medications and isolation complicate mental health issues in elders. In some settings, the social network for the elderly is reduced to other residents and the facility’s staff.
“That’s why it’s so important for the staff to be supportive and understand symptoms and behaviors presented as the result of mental illness, offering a safe and caring environment in which to keep the person’s dignity and respect intact,” he says. “Support can offer some relief.”
In long-term care facilities, there is a prevalence of mental health problems in elders, as well as a high turnover rate and shortage of direct care workers, Charland says. It is estimated that more than 60 percent of persons in nursing facilities and 53 percent in residential care have mental health diagnoses. Charland cautions that a small percentage of the elderly population is in institutional care, and these numbers do not reflect mental health issues of the general population of adults age 65 and older.
Training staff in how to deal with mental health problems has been shown to improve patient outcomes, including fewer depressive symptoms and better management of aggressive behaviors. Staff members have greater job satisfaction and better job performance.
“Understanding the best ways to interact with presenting behaviors can impact the older adult’s quality of life,” says Charland. “This is a proactive approach to increase preventative skills of workers to anticipate and redirect disruptive behaviors.”
Charland also compiled research on best practices for addressing elder suicide. He found only two states, Oregon and Pennsylvania, have formal elder suicide prevention plans in place.
“Most state suicide prevention programs are targeted to youth, but now Maine is starting to take a lifespan approach inclusive of all age groups.”
In Maine, more than 18 percent of all suicides � approximately 30 a year � occur after age 65, which mirrors the national average. Nationally, the rate of suicide among white men age 85 and older is 4.6 times greater than the rate for all ages.
Among the risk factors for elder suicide: loss of spouse, living alone, access to lethal means, and physical and mental illness.
Charland’s three major recommendations involve more frequent depression screenings for elders in primary care settings, coordination of elder suicide prevention efforts with the existing Maine Youth Suicide Prevention Program, and training for “gatekeepers,” like volunteers who deliver meals, in order to identify at-risk older adults and refer them for help.
“The most compelling finding was that screenings for depression by primary care physicians have the most promising effect,” Charland says. “Older adults trust their doctors and are willing to talk to them about mental health issues when they may not want to go to a psychologist or psychiatrist.”
Above all, when caring for elders with mental health issues, it’s important to see the people, not their disease or challenging behaviors, says Charland, who completes his graduate work in May.
“It’s been a great opportunity to work on these two projects knowing the end products will be used in one way or another to positively impact the lives of older Mainers.”
May – June 2007
Image Description: Jason Charland