Community Mental Health for Older People

Gerard J. Byrne; Christine C. Neville

BOOK

Community Mental Health for Older People

Gerard J. Byrne | Christine C. Neville

(2010)

Additional Information

Book Details

ISBN: 978-0-7295-7899-8
Edition
Language: English
Pages: 288
Subjects: Public health & preventive medicine
Nursing
Geriatric nursing

Abstract

Community Mental Health for Older People is the perfect resource for mental health workers as it discuses the ageing population, within the context of community mental health. It provides a comprehensive overview of the important issues and clinical practices that influence mental health care for older people. Written from a multidisciplinary perspective it is suitable for all health workers in community mental health teams (Aboriginal and Torres Strait Islander health workers, clinical psychologists, consumer representatives, medical practitioners, occupational therapists, registered nurses, social workers, etc) as it incorporates the use of case studies to aid in the application of evidence-based practice.

Multidisciplinary approach serves to illustrate the breadth and context of mental issues for older people

Chapters are topical and relevant, discussing issues such as service provision, cultural and rural issues, major disorders and interventions, as well as ethical and legal issues.

Vignettes are included throughout the clinical chapters and serve to illustrate real cases derived from practice

Evidence-based practice is a key element to this pivotal new text as it highlights the best method of practise, in a clear and accessible manner.

Highly readable style without the bulkiness of excessive references

This text will cover issues relevant to the mental health of older people within a community context in Australia and New Zealand. Issues will include population health and the clinical management of the major concerns experienced with the diverse clinical presentations by older people. The mental health care of older people is now considered a specialist area with older person’s mental health services being key components of the mental health service framework. The publication is primarily aimed at health workers in community mental health teams (registered nurses, clinical psychologists, medical practitioners, social workers, occupational therapists, Aboriginal and Torres Strait Islander health workers etc), but would incorporate those trainee health professionals involved in relevant undergraduate and postgraduate studies.

Section Title	Page	Action	Price
Front Cover\r	Cover
Community Mental Health for Older People\r	iii
Copyright\r	iv
FOREWORD	v
CONTENTS	vii
PREFACE	ix
ABOUT THE AUTHORS	ix
REVIEWERS	x
ACKNOWLEDGMENTS	x
SECTION 1	1
Chapter 1\rPOPULATION HEALTH AND BURDEN OF DISEASE	1
INTRODUCTION	1
THE AGEING POPULATION	1
HOSPITAL CARE	3
RESIDENTIAL AGED CARE	3
EPIDEMIOLOGY	4
BURDEN OF DISEASE	7
SUMMARY	8
REFERENCES	8
Chapter 2\rNORMAL, HEALTHY AND SUCCESSFUL AGEING	10
INTRODUCTION	10
NORMAL AGEING	10
HEALTHY AGEING AND SUCCESSFUL AGEING	13
BRAIN RESERVE	14
THE CLINICIAN’S ILLUSION	14
SUMMARY	14
Chapter 3\rEVIDENCE-BASED CARE IN THE COMMUNITY	16
INTRODUCTION	16
QUANTITATIVE VERSUS QUALITATIVE METHODS	16
THE SCIENTIFIC METHOD	17
TYPES OF EVIDENCE	17
OTHER ISSUES IN RELATION TO EVIDENCE	22
HOW TO LOCATE THE EVIDENCE	24
EXAMPLES OF EVIDENCE	24
SUMMARY	27
Chapter 4\rMODELS OF MENTAL HEALTHCARE AND ORGANISATIONAL ISSUES	28
INTRODUCTION	28
AREA-BASED SERVICES	28
INTEGRATED HOSPITAL AND COMMUNITY SERVICES	29
PRIVATE SECTOR SERVICES	30
WHO CARES FOR THE ‘GRADUATES’?	31
WHO CARES FOR PEOPLE WITH DEMENTIA?	31
TRANSCULTURAL ISSUES	32
SOURCES OF REFERRALS	32
DOMICILIARY OR CLINIC-BASED CONSULTATIONS	32
CASE MANAGEMENT MODEL	33
CONSULTATION–LIAISON MODEL	33
THE DAY HOSPITAL	33
THE MEMORY CLINIC	33
RESIDENTIAL AGED CARE FACILITIES	34
INVOLUNTARY CARE IN THE COMMUNITY	34
THE POLICE SERVICE	34
SOCIAL AND COMMUNITY SERVICES	35
SUMMARY	35
REFERENCES	35
Chapter 5\rCOMMUNITY MENTAL HEALTH TEAMS	36
INTRODUCTION	36
TEAM SIZE	36
TEAM COMPOSITION	36
LEADERSHIP	37
TEAMWORK	37
WORKLOAD	37
GENERIC CLINICAL ROLES	37
THE VALUE OF DIFFERENT PERSONALITY TYPES	38
THREATS TO TEAM COHESION	38
TOLERANCE AND HUMOUR	38
PROFESSIONAL SUPERVISION	39
OPERATIONAL MODELS	39
DOMICILIARY ASSESSMENT AND CARE	39
AGE POLICY	40
ADMINISTRATIVE SUPPORT	40
TEACHING AND TRAINING ROLES	40
PERSONNEL TRAINING	41
COMMUNICATIONS	41
TRANSPORT	41
RECORD-KEEPING ISSUES	42
AUDIT ACTIVITIES	42
RESEARCH ACTIVITIES	42
TEAM MEETINGS	42
BURNOUT	43
SUMMARY	43
REFERENCE	43
SECTION 2	45
Chapter 6\rCULTURAL ISSUES	45
INTRODUCTION	45
CULTURAL DIVERSITY	45
CULTURAL AWARENESS	46
CULTURAL SENSITIVITY	49
CULTURAL COMPETENCE	50
SUMMARY	52
USEFUL WEBSITES	53
REFERENCES	53
Chapter 7\rSOCIAL ISSUES	55
INTRODUCTION	55
AGEISM	55
GENDER	56
MARITAL STATUS	57
SEXUAL ORIENTATION AND GENDER IDENTITY	58
SUMMARY	59
USEFUL WEBSITES	59
REFERENCES	60
Chapter 8\rISSUES IN RURAL AND REMOTE LOCATIONS	61
INTRODUCTION	61
DEMOGRAPHICS	61
THE MENTAL HEALTH OF OLDER PEOPLE IN RURALAND REMOTE LOCATIONS	63
RURAL VALUES	63
ACCESS TO MENTAL HEALTH SERVICES	63
SOCIAL ISOLATION	65
THE POSITIVES OF RURAL AND REMOTE AREA WORK	66
SUMMARY	67
USEFUL WEBSITE	67
REFERENCES	67
Chapter 9\rCONSUMERS AND CARERS	69
INTRODUCTION	69
CONSUMER AND CARER PARTICIPATION IN MENTAL HEALTH SERVICES	69
SUPPORT	70
SPECIAL CHARACTERISTICS OF OLDER CONSUMERS	72
SPECIAL POPULATIONS	72
SPECIAL CHARACTERISTICS OF CARERS FOR OLDER PEOPLE	73
CARER BURDEN	74
INTERVENTION STRATEGIES TO SUPPORT CARERS	74
SUMMARY	76
USEFUL WEBSITES	76
REFERENCES	77
Chapter 10\rCONSULTATION–LIAISON SERVICES TO RESIDENTIAL AGED CARE FACILITIES	78
INTRODUCTION	78
RESIDENTIAL AGED CARE	78
THE CONSULTATION–LIAISON PROCESS	80
INTERVENTIONS	82
SUMMARY	82
REFERENCES	83
SECTION 3	85
Chapter 11\rTHE THERAPEUTIC RELATIONSHIP	85
INTRODUCTION	85
PERSON-CENTRED CARE	85
THE SICK ROLE	86
THERAPEUTIC ALLIANCE	86
TRANSFERENCE AND COUNTERTRANSFERENCE	87
DEPENDENCY	87
SABOTAGE AND SPLITTING	88
BOUNDARY ISSUES	88
COGNITIVE IMPAIRMENT	89
INSIGHT	89
CHALLENGING THERAPEUTIC RELATIONSHIPS	89
MEASURING THE THERAPEUTIC RELATIONSHIP	90
SUMMARY	90
FURTHER READING	90
REFERENCES	90
Chapter 12\rPSYCHIATRIC HISTORY TAKING	92
INTRODUCTION	92
SOURCES OF INFORMATION	92
PREPARATION FOR THE INITIAL HOME VISIT	92
ENGAGEMENT OF THE PERSON’S GENERAL PRACTITIONER	93
THE HOME VISIT	93
VISITING A RESIDENTIAL AGED CARE FACILITY	94
INTRODUCTION TO TAKING THE HISTORY	94
COMPREHENSIVE PSYCHIATRIC HISTORY	95
SHORTCUTS TO HISTORY TAKING	97
BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA	98
SUMMARY	98
Chapter 13\rTHE MENTAL STATE EXAMINATION	99
INTRODUCTION	99
CULTURAL ISSUES	99
SENSORY IMPAIRMENT	100
DETAILED MENTAL STATE EXAMINATION	100
SUMMARY	106
FURTHER READING	106
REFERENCES	106
Chapter 14\rCLINICAL COGNITIVE ASSESSMENT	107
INTRODUCTION	107
CONTEXT OF COGNITIVE ASSESSMENT	107
COMPONENTS OF CLINICAL COGNITIVE TESTING	108
COMPONENTS OF MEMORY	108
SCREENING INSTRUMENTS	109
MINI-MENTAL STATE EXAMINATION	109
NEWER COGNITIVE SCREENING SCALES	111
MEMORY TESTING	112
FRONTAL EXECUTIVE TESTING	112
FORMAL NEUROPSYCHOLOGICAL TESTING	113
THE RESIDENTIAL AGED CARE FACILITY RESIDENT	114
WRITING REPORTS	114
SUMMARY	114
REFERENCES	115
Chapter 15\rPHYSICAL HEALTH ASSESSMENT	116
INTRODUCTION	116
MEDICAL HISTORY	116
PERSONNEL INVOLVED IN THE PHYSICAL EXAMINATION	117
EQUIPMENT NEEDED FOR THE PHYSICAL EXAMINATION	117
FACTORS TO BE CONSIDERED IN THE PHYSICAL EXAMINATION	118
REASONS WHY PHYSICAL EXAMINATIONS ARE SOMETIMES NOT DONE	122
MEDICATION REVIEW	122
LABORATORY INVESTIGATIONS	122
NEUROIMAGING	123
ELECTROCARDIOGRAM	124
ELECTROENCEPHALOGRAM	124
NEUROPSYCHOLOGICAL TESTING	124
COMMON GENERAL MEDICAL CONDITIONS	125
SUMMARY	128
REFERENCES	129
Chapter 16\rFUNCTIONAL ASSESSMENT	130
INTRODUCTION	130
FUNCTIONAL ASSESSMENT	130
ACTIVITIES OF DAILY LIVING AND INSTRUMENTALACTIVITIES OF DAILY LIVING	131
AN OCCUPATIONAL THERAPY ASSESSMENT	133
SUMMARY	133
USEFUL WEBSITE	133
REFERENCES	133
Chapter 17\rPSYCHOSOCIAL AND SPIRITUAL ASSESSMENT	135
INTRODUCTION	135
PSYCHOSOCIAL FACTORS	135
SPIRITUALITY	137
SUMMARY	139
FURTHER READING	139
USEFUL WEBSITE	139
REFERENCES	139
Chapter 18\rRISK ASSESSMENT	141
INTRODUCTION	141
FALLS	141
ABUSE AND NEGLECT	142
AGGRESSION	146
SELF-NEGLECT	147
SUMMARY	147
USEFUL WEBSITES	148
REFERENCES	148
SECTION 4	151
Chapter 19\rTHE OLDER PERSON WITH CONFUSION	151
INTRODUCTION	151
CLINICAL CONTEXT	151
EPIDEMIOLOGY	152
CLINICAL FEATURES	152
AETIOLOGY	153
COMORBIDITY	154
DIFFERENTIAL DIAGNOSIS	154
ASSESSMENT	155
TREATMENT OUTLINES	160
PREVENTION	162
SUMMARY	163
REFERENCES	163
Chapter 20\rTHE OLDER PERSON WITH MOOD SYMPTOMS	164
INTRODUCTION	164
EPIDEMIOLOGY	165
RISK FACTORS	166
CLINICAL FEATURES	167
COMORBIDITY	168
DIFFERENTIAL DIAGNOSIS	168
ASSESSMENT	170
TREATMENT PRINCIPLES	172
PREVENTION OF DEPRESSION	175
MANIA IN OLDER PEOPLE	175
SUMMARY	177
REFERENCES	177
Chapter 21\rTHE OLDER PERSON WITH SUICIDAL THOUGHTS	179
INTRODUCTION	179
EPIDEMIOLOGY	180
TYPES OF SUICIDAL BEHAVIOURS	182
METHODS OF SUICIDE	182
RISK FACTORS	182
ASSESSMENT	184
TREATMENT	185
THE AFTERMATH OF SUICIDE	187
PREVENTION	187
SPECIAL TOPICS	188
SUMMARY	189
USEFUL WEBSITES	189
REFERENCES	189
Chapter 22\rTHE OLDER PERSON WITH PSYCHOTIC SYMPTOMS	191
INTRODUCTION	191
EPIDEMIOLOGY	191
CLINICAL FEATURES	192
PSYCHOTIC DISORDERS	195
ASSESSMENT	195
TREATMENT OUTLINE	197
SUMMARY	198
REFERENCES	199
Chapter 23\rTHE OLDER PERSON WITH ANXIETY	200
INTRODUCTION	200
EPIDEMIOLOGY	201
CLINICAL FEATURES	201
AETIOLOGY	204
COMORBIDITY	204
DIFFERENTIAL DIAGNOSIS	204
ASSESSMENT	204
TREATMENT PRINCIPLES	206
PREVENTION	212
SUMMARY	212
REFERENCES	212
APPENDIX A: GERIATRIC ANXIETY INVENTORY	213
Chapter 24\rTHE OLDER PERSON WITH SUBSTANCE ABUSE	214
INTRODUCTION	214
THE SPECTRUM OF SUBSTANCE ABUSE	215
EPIDEMIOLOGY	216
DIFFERENTIAL DIAGNOSIS	216
RISK FACTORS	216
SCREENING TOOLS	217
ASSESSMENT	218
MANAGEMENT	219
TREATMENT	219
PREVENTION	223
SUMMARY	223
USEFUL WEBSITES	223
REFERENCES	224
Chapter 25\rTHE OLDER PERSON WITH PERSONALITY DISORDER	225
INTRODUCTION	225
PERSONALITY	226
EPIDEMIOLOGY	226
CLINICAL FEATURES	227
COMORBIDITY	231
DIFFERENTIAL DIAGNOSIS	231
ASSESSMENT	231
TREATMENT PRINCIPLES	232
SUMMARY	234
REFERENCES	234
SECTION 5	237
Chapter 26\rPREVENTION AND PROMOTION	237
INTRODUCTION	237
A MODEL OF MENTAL HEALTH INTERVENTION	238
PREVENTION CONCEPTS	239
Primary prevention	239
Secondary prevention	240
Tertiary prevention	241
HEALTH PROMOTION	242
SUMMARY	242
USEFUL WEBSITES	243
REFERENCES	243
Chapter 27\rCOMMUNITY MANAGEMENT OF ACUTELY ILL OLDER PEOPLE	245
INTRODUCTION	245
LEGAL ISSUES	245
MEDICAL ISSUES	245
WHAT CONSTITUTES AN EMERGENCY?	246
INDICATIONS FOR HOSPITAL ADMISSION	246
ALTERNATIVES TO HOSPITAL ADMISSION	246
ASSESSMENT OF RISK	246
MEDICAL WORK-UP IN THE COMMUNITY	247
ACUTE MANAGEMENT OF PSYCHOSIS	247
ACUTE MANAGEMENT OF DEPRESSION	248
ACUTE MANAGEMENT OF DELIRIUM	248
ACUTE MANAGEMENT OF DEMENTIA	248
SUMMARY	249
Chapter 28\rMANAGEMENT OF BEHAVIOUR IN DEMENTIA	250
INTRODUCTION	250
PREVALENCE	250
SIGNIFICANCE	251
SYMPTOM CLUSTERS	251
DIFFERENTIAL DIAGNOSIS	251
AETIOLOGY	252
SCALES TO MEASURE BPSD	252
INITIAL ASSESSMENT OF BPSD	253
MANAGEMENT OF BPSD	254
SERVICE DELIVERY ISSUES	257
SUMMARY	258
REFERENCES	258
Chapter 29\rPSYCHOTHERAPEUTIC TREATMENT	261
INTRODUCTION	261
SPECIAL ISSUES CONCERNING OLDER PEOPLE	261
COGNITIVE BEHAVIOUR THERAPY	262
BEHAVIOUR THERAPY	264
PSYCHODYNAMIC THERAPY	265
SUPPORTIVE PSYCHOTHERAPY	265
PROBLEM-SOLVING THERAPY	266
LIFE REVIEW AND REMINISCENCE THERAPY	267
INTERPERSONAL THERAPY	267
PSYCHOEDUCATION	267
FAMILY THERAPY	268
COUNSELLING AND CRISIS INTERVENTION	268
SUMMARY	269
REFERENCES	269
Chapter 30\rPHARMACOLOGICAL TREATMENT	271
INTRODUCTION	271
CORE CONCEPTS IN PSYCHOPHARMACOLOGY	271
PHARMACOKINETIC AND PHARMACODYNAMIC CHANGESIN OLDER PEOPLE	272
POLYPHARMACY	272
PRINCIPLES OF DRUG TREATMENT	273
DRUG ADMINISTRATION ISSUES	273
ANTIDEPRESSANTS	274
MOOD STABILISERS	276
ANTIPSYCHOTICS	276
COGNITION ENHANCERS	278
SEDATIVES AND HYPNOTICS	279
MENTAL HEALTH PROBLEMS NOT USUALLY TREATEDWITH MEDICATION	279
COMPLEMENTARY MEDICINE	280
SUMMARY	280
REFERENCES	281
Chapter 31\rELECTROCONVULSIVE THERAPY AND OTHER PHYSICAL TREATMENTS	282
INTRODUCTION	282
ELECTROCONVULSIVE THERAPY	282
PHYSICAL ACTIVITY	285
LIGHT	285
OTHER TREATMENTS	286
SUMMARY	286
REFERENCES	286
SECTION 6	289
Chapter 32\rLEGAL AND ETHICAL ISSUES	289
INTRODUCTION	289
INFORMED CONSENT	289
INVOLUNTARY DETENTION AND TREATMENT	290
PRIVACY AND CONFIDENTIALITY	290
BALANCING AND MANAGING RISK	291
GUARDIANSHIP AND ADMINISTRATION	291
RESEARCH PARTICIPATION	291
END-OF-LIFE ISSUES	291
CAPACITY	292
SUMMARY	297
REFERENCES	297
Chapter 33\rDRIVING	298
INTRODUCTION	298
OLDER DRIVERS	298
AGE-RELATED FACTORS	298
DEMENTIA AND DRIVING	299
INTERVENTIONS	299
SUMMARY	301
REFERENCES	301
Chapter 34\rPALLIATIVE AND END-OF-LIFE CARE	302
INTRODUCTION	302
THE ROLE OF THE MENTAL HEALTH WORKER	303
MENTAL HEALTH ISSUES	303
THE OLDER PERSON AND FAMILY ASSESSMENT	305
DEATH AND DYING	305
SUMMARY	306
REFERENCES	307
SECTION 7	309
Chapter 35\rRATING SCALES	309
INTRODUCTION	309
GLOBAL ASSESSMENT	311
COGNITIVE ASSESSMENT	311
FUNCTIONAL ASSESSMENT	312
SOCIAL ASSESSMENT	312
BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMSOF DEMENTIA	313
DEPRESSION	313
SUICIDE	314
DEMENTIA	314
ANXIETY	315
SUBSTANCE ABUSE	315
CAGE questionnaire	315
PAIN	316
QUALITY OF LIFE	316
CARER WELLBEING AND BURDEN	317
SUMMARY	317
REFERENCES	317
Chapter 36\rOUTCOME EVALUATION	320
INTRODUCTION	320
LARGE-SCALE OUTCOME MEASUREMENT	320
SYMPTOM REDUCTION	324
QUALITY OF LIFE	325
CONSUMER AND CARER SATISFACTION	326
SUMMARY	328
USEFUL WEBSITES	328
REFERENCES	328
INDEX	331

Community Mental Health for Older People

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