geria journal

8/3/2019 Geria Journal

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Primary Care Doctors OverlookMental Health in Older Adults

Even symptoms of severe depression have been ignored

By Sharon O'Brien, About.com Guide

Doctors spend little time discussing mental health issues with their older patientsand rarely refer them to a mental health specialist even if they show symptoms ofsevere depression, according to a study funded by the National Institute of MentalHealth and published December 2007 in the Journal of the American Geriatrics Society.Suicide Rate Higher in People age 65 and Older While people age 65-plus represent 12

percent of the U.S. population, they accounted for a disproportionate 16 percent ofsuicide deaths in 2004. The study suggests that improved mental health screening inprimary care may improve detection and treatment of mental disorders before drasticconsequences, such as suicide, can occur.

How the Eldercare Mental Health Study Was DoneTo determine how doctors deliver mental health care to older adults, researchersanalyzed 385 videotaped visits of 35 doctors with 366 of their senior patients, identifyingtopics discussed and how much time was devoted to each topic.

Here's what the researchers found:

Mental health-related topics occurred in 22 percent of visits, typically lastingabout two minutes

An average visit lasted about 16 minutes overall, and the majority of that timewas spent discussing biomedical and other topics.

Among doctors who address mental health issues during patient visits, theirefforts to treat or provide care for a mental health issue varied widely. Most doctors fellinto one of these three patterns of care: listening to the patient for an extended period oftime and referring him or her to a mental health care specialist; gathering informationbut providing inadequate treatment; or being dismissive toward the patient and his orher emotional distress, and failing to follow up.

More female patients (27 percent) discussed a mental health topic during atypical visit than male patients (12 percent).In addition, researchers discovered that the gender pairing of doctor and patientaffected the likelihood of discussing mental health issues. Women patients talking tofemale doctors were most likely to discuss mental health, while male patients with maledoctors were least likely.
http://seniorliving.about.com/bio/Sharon-O-Brien-11931.htmhttp://seniorliving.about.com/bio/Sharon-O-Brien-11931.htm


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Primary Care Doctors Need Support to Increase Focus on Mental HealthThe study researchers concluded that primary care doctors need more support in howto identify, treat and refer patients to mental health specialists. This can be especiallyimportant when treating older adults, who may be more isolated from family and friendswho would notice behavior and mood changes.

Reaction:

Talking about feelings, fears and negative thoughts, as well as how to manage

them, can help alleviate depression, though it can be difficult to communicate at first

when feeling low. Counselling can be useful as a sole treatment or in addition to

antidepressants. There are many ways to reduce the risk of developing depression.

Looking after one's physical, emotional, spiritual and social wellbeing is likely to lift the

mood, enhance self-esteem and foster a sense of being meaningfully connected to the

world. This is the best defence against depression, and small steps in these areas mark

the way to lasting recovery.


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The Importance of Balance Exercises for Elderly People

SeniorJournal.com published an article in which a study published in the Journal of

Gerontology was cited and explained. The study, conducted on patients aged 70 to 89,

showed that scores on physical mobility testing for the elderly can be improved with the

use of regular exercise. This affects the ability of the elderly to function and have a more

independent lifestyle.

Improved balance not only aids in mobility, but it helps reduce the risk of fallingand sustaining serious injury. A study published in Geriatrics and GerontologyInternational concluded that because of the affect the weakening of lower limbs has onpeople as they age, something as simple as ankle exercises can be effective in helping

to maintain balance and help prevent falls. Daily activity such as standing on tiptoe,walking on uneven surfaces and using stairs can be safer when balance is improved.

A Word of Caution: Before any new exercise is undertaken, a consultation with adoctor is recommended. Additionally, doing warm-up exercises (such as walking) for atleast five minutes prior is advised. If your balance is poor, it is important for safety tohave someone nearby to assist you.

Tai Chi, Pilates and Gentle YogaMultiple resources recommend one or a combination of these as part of a

balance-oriented exercise program for the elderly. Tai Chi, Pilates and gentle yoga allcan help build strength, endurance and balance. Additionally, all can be undertaken bya very sedentary person and increased in intensity, as the individual is able to do so.Whether it is through a personal trainer, class, television show, DVD or video tape, besure it is specifically geared for senior citizens or the elderly.

Non-Exercise Balance ExercisesThere are non-exercise means of improving balance. These balance exercises

for elderly people can be incorporated into simple everyday activities. The NationalInstitute on Aging and the National Institutes on Health suggest:

Standing on one foot while resting one hand on a countertop, chair or wall, forsupport. Hold the position for 10 seconds; repeat for each leg 10-15 times. Do two

cycles.Walk heel-to-toe for 20 steps, arms outstretched for balance. Stay focused on

something straight ahead while walking.Hip extensions are another movement done while holding onto something like a

chair or countertop for balance. With your weight on one foot, raise the other leg behindyou. Tuck your tailbone in, and use the abdominal muscles to help. Flex your foot whileraising your leg. Hold for about one second and then lower leg. Repeat 10 15 timesfor each leg. Do two cycles.
http://www.brighthub.com/guides/exercise.aspxhttp://www.brighthub.com/guides/exercise.aspxhttp://www.brighthub.com/guides/exercise.aspxhttp://www.brighthub.com/guides/exercise.aspx


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Side leg raises are done while holding onto something like a chair for balance.Slowly lift one leg outward, with a straight back and forward-facing toes. Hold for aboutone second and then lower leg. Repeat 10 -15 times for each leg. Do two cycles.

Back leg raises can be done while holding onto a chair or countertop. Simply liftone leg straight back slowly. Hold for about one second and then lower. Repeat this 10to 15 times for each leg. Do two cycles.

References:Senior Citizens Gain Health, Independence, Balance with Exercise. November 22,2006. Senior Journal. http://seniorjournal.com/NEWS/Fitness/6-11-22-SeniorCitizensGain.htmAnkle exercises build seniors strength, balance. Reuters. (Source: Geriatrics andGerontology International, March 2009).http://www.reuters.com/article/idUSTRE52563D20090306

U.S National Institutes of Health. National Institute on Aging. Exercise & PhysicalActivity: Your Everyday Guide from the National Institute on Aging. Last updatedNovember 11, 2009.http://www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide/default.htmExercise and Physical Activity for Older Adults. Exercises to Try Balance Exercise.Last Reviewed January 20, 2010. National Institutes of Health Senior Health.http://nihseniorhealth.gov/exerciseforolderadults/balanceexercises/01.html

Reaction:

Arguably, the best reason for being physically active is that it can be fun, and a

way of getting away from the stresses and strains of everyday life. Whatever activitiesyou choose - and whether you do it in a group or on your own, indoors or out - you're

likely to benefit psychologically. The other health benefits of exercise are already well

known. People who are regularly active are at half the risk of developing coronary heart

disease. It reduces high blood pressure, obesity and high cholesterol.

Keeping up an active lifestyle is good for the bones, joints and muscles and can

help to delay osteoporosis and arthritis. In keeping muscles strong and flexible, you can

participate in everyday life to the full, with less risk of injury or falling. Being physically

active can also help control conditions such as diabetes, and make you less exposed to

some cancers (in particular bowel cancer).Physical activity has many positive benefits

for both physical and mental health, particularly for specific conditions such as

depression.Our physical ability changes as we age.
http://nihseniorhealth.gov/exerciseforolderadults/balanceexercises/01.htmlhttp://nihseniorhealth.gov/exerciseforolderadults/balanceexercises/01.html


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Geriatric Inmates Face

Challenges Unique to PrisonBrie Williams, MD -----

The prison inmate population is aging rapidly, but prisons have not yet

adapted to the physical and mental needs of geriatric prisoners, according to a

study conducted by researchers at the San Francisco VA Medical Center.

The study, which analyzed questionnaire responses by 120 female

prisoners aged 55 or older in the California prison system, appears in the April

2006 issue of the Journal of the American Geriatrics Society. It is currently

available in the Online Early issue of the journal.

Prison is a not a safe place for vulnerable older people to be, says leadauthor Brie Williams, MD, a geriatrician at SFVAMC. Prisons arent geared to

the needs and vulnerabilities of older people. In the prison environment, there are

a number of unique physical tasks that must be performed every day in order to

retain independence. Theyre not the same tasks that are called for in the

community. According to the study, while many aging prisoners share the same

challenges faced by their counterparts in the community - such as bathing,

dressing, and using the bathroom - they also must perform activities of daily

living that are specific to prison. These include dropping to the floor rapidly when

an alarm goes off, climbing onto a top bunk, hearing orders from correctional

officers, standing in line to be counted, and walking to the dining hall, which may

be a considerable distance from a prisoners cell.

When an alarm goes off, every inmate has to get down on the floor

immediately, in order for the staff to maintain control of the inmates. Even some

people in wheelchairs are expected to get out of their chairs and onto the floor,

explains Williams, who is also a fellow in aging research at the University of

California, San Francisco. You can imagine that for someone who has trouble

walking, or with brittle bones, a very quick drop to the floor can be quite

hazardous. And alarms may sometimes go off several times a day.

The study found that 69 percent of the women reported that at least one

prison activity of daily living was very difficult to perform. Sixteen percent

reported needing help with one or more daily activity - twice the rate of the

general U.S. population aged 65 and older - and 51 percent reported falling in the

previous year.


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The women were also less healthy than the general population, reporting

significantly higher rates of hypertension, asthma or other lung disease, and

arthritis.

According to Williams, the issue of physical independence for older

prisoners is becoming increasingly urgent. She observes that the prison system

was never designed or built for geriatric prisoners, yet the population of older

prisoners in the United States is increasing exponentially, with the number of

geriatric female prisoners in California up 350 percent in the last decade. It is

projected that by 2030 ... one third of the U.S. prison population will be geriatric,

write the study authors.

For the short term, Williams makes several recommendations that she

says would help make prisons safer for older inmates: Every prisoner 55 andover should be assigned to a bottom bunk unless the person specifically requests

otherwise, and should be in a cell with grab bars near the toilets. They should be

housed closer to the dining hall, and given more time to drop to the floor during

alarms. There should be grab bars in showers, and rubber mats on shower

floors.

She points out that these modifications would make prison safer for

younger inmates with physical impairments as well.

Williams also expresses broader, more long-term concerns. As three-

strikes laws and mandatory minimum sentencing laws become stricter, more and

more people will be spending their entire lives, including old age, in prison, she

observes. In addition to the economic burden, the incarceration of the elderly

poses fundamental questions of how we as a society treat our elders. What do

we, as a society, want to do with a prisoner who is so demented he doesnt

remember his name, or who has had a stroke and is completely paralyzed? As a

physician and as a citizen, I think we need to ask how we can make society safe

but also have a reasonable system of incarceration.

Co-authors of the paper are Karla Lindquist, MS, of UCSF; Rebecca L.Sudore, MD, of SFVAMC and UCSF; Heidi M. Strupp and Donna J. Willmott,

MPH, of Legal Services for Prisoners with Children; and Louise C. Walter, MD, of

SFVAMC and UCSF.

The research was supported by funding from the Department of Veterans

Affairs and a grant from the National Institute on Aging that was administered by


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