Conference held at Friends Hospital on October 2, 2002
Full Circle Theatre from Temple University woke everyone up with a wonderful, energetic performance. The improvisational group put audience members to working understanding mental health and aging issues. They asked people to talk about their own good and bad experiences with aging, caretaking, and the mental health and aging systems. Then the actors (who ranged in age from 40 to 80 years old) built skits around the ideas that people shared. Full Circle ended with a skit showing us a vision of what healthy and happy aging should be.
Dr. Cynthia Zubritsky reported on the nationwide Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISMe) study which looked at the most effective way to deliver appropriate mental health/substance abuse services to older adults. Usually, instead of integrated care, most primary care doctors give seniors the name and phone number for a specialist and tell them to make a new appointment on their own. Many people think that integrated care will lead to better treatment for seniors with mental illnesses and drinking problems. The study compared care in a primary care setting to care by a specialist. Findings from research done by the University of Pennsylvania favored having assessment and treatment integrated into the primary settings as long as primary care physicians work closely with specialists. The results from all the 11 sites will be compiled in the coming year and then presented to the public.
Dr. David Olsin spoke on "Caring for Older Adults with Substance Abuse Problems". He noted that misuse and abuse of alcohol, psychoactive medications, and illicit drugs have become significant public health concerns for the growing population of older adults. The concern regarding substance abuse is highlighted by the literature demonstrating that the substance misuse and abuse are common in this population (see Blow, CSAT, Treatment Improvement Protocol #26, 1998, for a more complete discussion). Moreover, the elderly represent a group of adults who are particularly vulnerable to the effects of these substances, and as such, there is a need for a paradigm shift in the way clinicians and researchers think about the risks of use in this segment of the population.
Compared with younger adults, older individuals have an increased sensitivity to alcohol as well as a heightened response to over-the-counter and prescription medications. Typically, substance use problems are thought to occur only in those persons who use substances in high quantities and at regular intervals. However, for some patients, any alcohol use, coupled with the use of specific over-the-counter or prescription medications, can be problematic. Many of the acute and chronic medical and psychiatric conditions are negatively affected by lifestyle choices and behaviors such as the consumption of alcohol.
With the increasing awareness that older adults have specific risks when using alcohol and/or prescription medications, there has also been a growth in newer and more effective interventions and treatments. These interventions and treatments are effective and can lead to both reduced use of substances and improvements in overall health. It is, therefore, timely and imperative that older adults with problems related to alcohol and/or medication be identified and have appropriate treatments provided. He stressed how important it is for doctors and others to expand our definition of "problem" drinking when it comes to elders. Dr. Olsen also emphasized that elders with substance abuse problems are more open to intervention than younger people are. Studies show that talking about problem drinking with older patients is very effective at getting people to drink less.
Dr. George Simms finished the morning with comments on "Mental Health and Aging: From the perspective of a Primary Care Physician". Although he acknowledged the stresses and losses of growing older and of care taking, he asked the audience to keep in mind that there may be many profound gifts that we can only as a result of growing older. Lengthening life has left us with the dilemma, how do you find meaning in life in the midst of declining health. He challenged the present focus of mental health as the absence of certain symptoms. Rather mental health should be seen as positive focus on life incorporating. Simms said that research has pointed out six specific dimensions of positive functioning for all ages. They are self- acceptance, purpose in life, positive relations with others, environmental mastery, personal growth, and autonomy. Later life, despite prevailing expectations of decline, is a time when well being can be more than maintained, it can even get better.
He concluded by pointing that the last phase of our lives, our dying has within it an important gift, a graced experience of oneness to give the person who is capable of receiving it. Perhaps, in the final analysis, the journey to aging is the unrecognized, royal road to true maturity.
Afternoon Workshops presented information and advocacy strategies on current issues affecting older adults in Pennsylvania.
Kathy Latimer, Bonnie Popso and Jennifer Spears in "What we are learning from the State Pilot Projects" talked about the challenges and successes they have experienced in reaching out to seniors in rural and urban counties who may have an undiagnosed mental illness. "Elder Reach" in Erie county and "Senior Outreach and Referral" in Greene county encourage community members such as hairdressers, neighbors, church members, mail carriers and others to call them if there is a senior who seems to need help. Staff then visits the senior to see what his or her needs are, and to connect him or her to services.
Florrie Fisher and Verna Hightower spoke on "Supporting Caregivers of Older Adults with Mental Health Problems." Florrie spoke about the need to understand the caregiver perspective. She talked about the conflicted feelings of being overwhelmed, grief and anger that take place when the relationship to a spouse, friend or relative significantly changes. She spoke of how to assess the caregiver's needs from a psychosocial point of view. Verna then gave a moving account of her efforts to care for her husband who has had Alzheimer's disease for a number of years. Florrie gave suggestions for resources in the community and stressed the need to teach caregivers how to care for themselves.
Kevin Casey from Pennsylvania Protection and Advocacy gave an update on Personal Care Homes and Older Adults with Mental Health Problems. Right now the state has released a draft of new regulations for these homes, and advocates are in the process of reviewing them and giving feedback to the state. However, he stressed that even with these new regulations, things will not improve unless there is a unified voice from the aging and mental health communities demanding change.
Hikmah Gardiner spoke on how to organize older adults to advocate for better services and their peers. Speaking from her own experiences, Hikmah told about efforts by older adults and mental health consumers to take charge of their health and to work actively to make the system fit their needs. She gave tips on how to reach out to older adults such as getting older adults to lead peer discussions on mental health, meeting older adults in their own environment, having refreshments and informal discussion in order to create less stigmatizing and more comfortable, and incorporating older adults into advisory groups.