1 Marsha Frankel, LICSW Clinical Director of Senior Services-JF&CS Ruth Grabel, MPA Program Specialist and Coordinator, Massachusetts Partnership on Substance Use in Older Adults Massachusetts Department of Public Health April 10, 2013 Tips and Techniques for Supporting Residents with Mental Illness (C)JF&CS of Greater Boston All rights reserved 2013

OBJECTIVES Be able to name 3 common mental health problems in older adult residents Be able to identify at least 1 intervention strategy Increased comfort in knowing about and utilizing community resources to assist in managing mental health problems (C)JF&CS of Greater Boston All rights reserved

3 Impact on Staff What percentage of residents take up the majority of your time? How about the impact on other staff? Impact on others? (C)JF&CS of Greater Boston All rights reserved 2013

4 Instructions Write the name (first name or initials) of an elder who you find the most challenging During the rest of this presentation think about how or if the information relates to the older adult you identified (C)JF&CS of Greater Boston All rights reserved 2013

5 Most Common Psychiatric Diagnoses of Older Adult Residents Dementia Mood Disorders- Depression and Anxiety Substance Abuse- especially alcoholism Psychotic Disorders (C)JF&CS of Greater Boston All rights reserved 2013

Basic Assessment Skills Are there any significant changes in: Appearance Speech Physical Eye Contact Mood Cognition

7 Dementia in Independent Senior Housing (C)JF&CS of Greater Boston All rights reserved 2013

8 Dilemmas Safety vs. Autonomy Elder’s rights vs. safety for others Family dynamics No family When to call Protective Services and why (C)JF&CS of Greater Boston All rights reserved 2013

DEPRESSION (C)JF&CS of Greater Boston All rights reserved

10 Depression is a Biological Illness Reprinted from Mark George, MD Biological Psychiatry Branch, Division of Intramural Research Programs, NIMH, 1993 Non-Depressed BrainDepressed Brain (C)JF&CS of Greater Boston All rights reserved 2013

11 Risk Factors for Depression Genetics Prior history of depression Medical Illness/Medications Psychosocial stressors Cognitive: Behavioral and personality factors Trauma (C)JF&CS of Greater Boston All rights reserved 2013

12 Consequences of Depression Adherence to medical treatment Recovery from medical illness Quality of life Function and self-care Social relations Decrease in… (C)JF&CS of Greater Boston All rights reserved 2013

13 Consequences of Depression Isolation Use of health services Risk of suicide and overall mortality Increase in… (C)JF&CS of Greater Boston All rights reserved 2013

JOHN (C)JF&CS of Greater Boston All rights reserved

15 Guidelines for Screening Start where the elder is Ask direct questions Express a belief that no one should suffer needlessly Acknowledge how hard it is for anyone to admit depression and to seek help Hold out hope! Educate (C)JF&CS of Greater Boston All rights reserved 2013

16 Rates of Suicide in Older Adults Depression is the #1 risk factor for people who commit suicide High rate of completed suicides occur in older adults Elderly suicide may be under-reported by as much as 40% (C)JF&CS of Greater Boston All rights reserved 2013

ANXIETY DISORDERS (C)JF&CS of Greater Boston All rights reserved

18 Substance Abuse (C)JF&CS of Greater Boston All rights reserved 2013

19 Prescription Drug Misuse Approximately one third of all medications prescribed in U.S. are for people over 65 Unintentional misuse Intentional abuse may be as high as 11% (C)JF&CS of Greater Boston All rights reserved 2013

20 Alcohol Use and Abuse (C)JF&CS of Greater Boston All rights reserved 2013

21 Suicide and Substance Abuse Suicide= a leading cause of death among people of all ages who abuse alcohol and drugs Depression= common co-occurring diagnosis of substance abusers Acute alcohol intoxication exists in 30-40% of suicides and attempted suicides (C)JF&CS of Greater Boston All rights reserved 2013

22 Psychosis (C)JF&CS of Greater Boston All rights reserved 2013

23 Psychosis Up to 23% of all older adults will experience psychotic symptoms Dementia is the main cause in elders Visual and auditory deficits play a role (C)JF&CS of Greater Boston All rights reserved 2013

24 Identifying Potential Psychosis Look for changes in: Social functioning Cognition Mood Thought content Alcohol/drug use (C)JF&CS of Greater Boston All rights reserved 2013

25 Identifying Potential Psychosis Look for evidence of: Poor personal hygiene Delusional or bewildered mood Abstract or vague speech Sudden outbursts of anger or irritation (C)JF&CS of Greater Boston All rights reserved 2013

26 Paranoia More than 12% with dementia experience paranoid symptoms Causes distress for elder and caregivers Can be an acute mental status change Ranges from increased suspiciousness to persecutory delusions (C)JF&CS of Greater Boston All rights reserved 2013

27 Responding to Someone Experiencing Delusions (C)JF&CS of Greater Boston All rights reserved 2013

28 It Takes a Village Special project with JCHE Lessons learned- the role of The Team How to create a “village” (C)JF&CS of Greater Boston All rights reserved 2013

29 Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

30 Site Rep Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

31 Site Rep RSC Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

32 Site Rep RSC Police Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

33 Site Rep RSC Maintenance Police Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

34 Site Rep RSC Residents Maintenance Police Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

35 Site Rep MH Clinician RSC Residents Maintenance Police Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

36 Site Rep MH Clinician RSC Residents Maintenance MD Police Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

37 Site Rep MH Clinician RSC Residents Reduced Fee Attorney Maintenance MD Police Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

38 Site Rep MH Clinician RSC Residents Reduced Fee Attorney Maintenance MD Police Public Health Nurse Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

39 Site Rep MH Clinician Free Care Manager RSC Residents Reduced Fee Attorney Maintenance MD Police Public Health Nurse Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

40 Public Health Nurse Police MD PCA Maintenance Reduced Fee Attorney Residents RSC Free Care Manager MH Clinician Site Rep Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

41 Site Rep MH Clinician Free Care Manager RSC Residents Reduced Fee Attorney Hospice Maintenance MD Police Public Health Nurse Mrs. K Mrs. K’s Story (C)JF&CS of Greater Boston All rights reserved 2013

42 Conclusion “Takes a village” Collaboration: identifying community partners Seek support (C)JF&CS of Greater Boston All rights reserved 2013