|
|
|
|
Confuse psychopathology with normal aging |
|
Health care professional |
|
Patients |
|
Health care belief in treatment effectiveness |
|
Opposite probably true – alcoholism |
|
|
|
|
|
Move from in-patient to out-patient |
|
Issues of compliance |
|
Mentally ill young |
|
Mentally ill old |
|
New drugs |
|
New laws on involuntary commitment |
|
|
|
|
|
Primary reasons for increase in mentally ill in
nursing homes |
|
Move to outpatient treatment |
|
Changes in involuntary commitment |
|
Importance of this setting |
|
Relative prevalence in nursing homes |
|
Opportunity for treatment |
|
Actual treatment in nursing homes |
|
Estimated that could benefit – 30-45% |
|
Actually receive –7% |
|
|
|
|
|
What they receive: Drugs vs. Psychotherapy |
|
What is most effective |
|
Other treatments |
|
Cognitive therapy |
|
Behavioral therapy |
|
Relative availability for older |
|
|
|
|
|
|
|
Financial |
|
Private practice costs |
|
Limited number of sessions reimbursed |
|
Medicare/Medicaid reimbursement |
|
“Cheaper” measures to control behavior |
|
Drugs |
|
Thorizine shuffle |
|
restraint |
|
|
|
|
|
Mount Sinai, UCLA |
|
Geriatric teams |
|
Psychiatrist |
|
Psychologist |
|
Geriatric social worker |
|
|
|
Notes