serving older adults with behavioral health needs · 2019. 12. 18. · objectives •describe...
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Serving Older Adults with Behavioral Health Needs
Module 1: The Everyday Experience of Aging
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Presented by Oregon Health Authority, Health Systems Division and Portland State University Institute on Aging
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Older Adult and Behavioral Health Training
Introductory Modules
1. The Everyday Experience of Aging
2. Behavioral Health Partners in Older Adult Behavioral Health
3. Aging Services Partners in Older Adult Behavioral Health
Clinical Modules
4. What’s Happening with Gladys?
5. Bill’s Search for Lois
6. Has Anyone Seen George?
7. We Have Another Call About Nell!
8. Behavioral Health Issues and Advance Care Planning
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Background
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Objectives
• Describe positive mental and emotional health that is typical
for older adults.
• Demonstrate awareness of normal age-related (e.g., sensory, cognitive,
physical) changes with age and how these changes are related to
behavioral health.
• Provide examples of ways that older adults adapt to age-related changes.
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Objectives
• Describe positive mental and emotional health that is typical
for older adults.
• Demonstrate awareness of normal age-related (e.g., sensory, cognitive,
physical) changes with age and how these changes are related to
behavioral health.
• Provide examples of ways that older adults adapt to age-related changes.
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Objectives
• Describe positive mental and emotional health that is typical
for older adults.
• Demonstrate awareness of normal age-related (e.g., sensory, cognitive,
physical) changes with age and how these changes are related to
behavioral health.
• Provide examples of ways that older adults adapt to age-related changes.
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Mental Health:
A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her community
World Health Organization
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Good News!
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A typical week . . .
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What did you notice?
• Social engagement• Family
• Friends
• Community
• Meaningful activity• Volunteering
• Work
• Learning
• Self-care
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What did you notice?
Diversity of Experience
• Income
• Gender
• Age
• Ethnicity
• Living situation
• Sexual orientation
• Urban/rural
• Family structure
• Health
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Life Course Perspective
• Aging: A lifelong, intergenerational process• Linked lives: interdependence of individuals’ lives over time• Historical time• Social Structure
• Race • Class• Gender
• Place • Culture & spiritual domains• Economic conditions (e.g., income inequality, job opportunities, retirement policies)
• Individual agencyStowe & Cooney, 2015
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Example of life course influences
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Life course influences
• Multi-cultural lens
• Travel
• Polio
• Transgender
• Education
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Life course influences
• Multi-cultural lens
• Travel
• Polio
• Transgender
• Education
• Rural communities
• Boarding school
• Marital status
• Death of child
• Adventurer
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Emotional well-being
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Emotional well-being
• Goals related to Social Interaction• Gaining information
• Developing and maintaining identity
• Regulating emotions
Laura Carstensen & Colleagues
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Emotional well-being
• Social activity changes with age• The basic functions of social contact do not change
• Reflects lifelong selection process
• Emotional regulation greater centrality—people get better at it
Laura Carstensen & Colleagues
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Continuing development, emotional regulation
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Age-related changes in physical functioning
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Musculoskeletal changes—consequences• Decreased bone and muscle strength
• 2-inch loss in height
• Increase incidence of osteoporosis
• Decreased range of motion
• Decreased flexibility
• Decreased mobility
• Gait changes
• Increased risk of falls
• Changes in body image
24Retrieved from Merck Manual; Muscles
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Cardiovascular changes—consequences
• Decline in cardiac output
• Decline in endurance
• Less reserve capacity in heart function
• Increased blood pressure
• Electrocardiogram changes
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Courtesy of the National Institutes of Health (NIH)
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Neurological changes—consequences
• Slower response to stimuli
• Gait changes
• Decrease in deep tendon reflexes
• Sleep pattern disturbances
• Increased susceptibility to environmental temperature changes
• Decreased short-term memory
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Courtesy of the National Institute of Mental Health (NIMH)
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Additional consequences of physical changes
Gastrointestinal• Teeth more susceptible
to cavities
• Decreased taste sensation, appetite, chewing ability
• Problems with elimination
• Decreased tolerance for fat
• Changes in drug metabolism
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Additional consequences of physical changes
Genitourinary • Increased urinary frequency,
incidence of incontinence,
• Drug clearance via kidneys
• Sexual function
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Additional consequences of physical changes
Respiratory• Decreased vital lung capacity
• Decreased arterial blood oxygen level
• Decreased oxygen level
• Poorer exchange of carbon dioxide and oxygen
• Decreased exercise tolerance
• Increased risk of infection
Integumentary (skin)• Increased susceptibility to
infection, trauma, pressure ulcers
• Decreased skin turgor (firmness)
• Decreased ability to maintain body temperature
• Slower rate of healing
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Sensory changes
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Courtesy of National Institute of Deafness and Other Communication Disorders (NIDCD)
Courtesy of the National Eye Institute (NEI)
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Sensory changes: Hearing
• Decreased number of nerve cells
• Atrophy of bones in middle ear responsible for conveying sound to the inner ear
• Presbycusis (decreased ability to hear high frequency sounds)
• Increased production of ear wax (including “ear wax plugs”)
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Courtesy of National Institute of Deafness and Other Communication Disorders (NIDCD)
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Hearing changes—consequences
• High frequency loss first (consonants)
• Loss of tone discrimination
• Difficulty following conversation
• Ear wax impaction
• Social isolation
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Courtesy of U.S> National Library of Medicine
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Sensory changes: Vision
• Yellowing, rigidity of lens
• Decreased pupil size
• Narrowing of visual field
• Decreased number of cones in retina
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Courtesy of the National Eye Institute (NEI)
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Vision changes—consequences
• Inability to focus properly
• Distorted depth perception
• Decreased color discrimination
• Need for stronger light
• Increased sensitivity to glare
• Decreased light and dark adaptation
• Loss of peripheral vision
• Drier corneas
• Increased social isolation
34Courtesy of the NIH SeniorHealth
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Function
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Function
More than:
• Activities of daily living (ADL)
• Instrumental activities of daily living (IADL)
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Functional assessments
• Interdisciplinary focus
• Oregon Geriatric Education Center
• “Try This” —www.consultgerirn.org
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Function
• Quality of life
• Do the things you want to do
• Be with the people you want to be with
• Maintain abilities
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Adaptation
• Selectivity
• Optimization
• Compensation
Baltes & Baltes and colleagues
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Selectivity, Optimization, and Compensation
Selectivity• Narrow activities
• Choose those that are most important
Baltes & Baltes, 1990
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Selectivity
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Selectivity
• Prioritizing tasks
• Doing what is most important
• Change in living situation: • Reduce isolation,
• Being with family/friends
• Preserving energy
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Selectivity, Optimization, and Compensation
Optimization• Preserve
• Enhance potential for success or satisfaction
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Optimization
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Optimization
• Exercise and diet to preserve physical and intellectual abilities
• Doing tasks when rested
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Selectivity, Optimization, and Compensation
Compensation • Making adaptations
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Compensation
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Compensation
• Adapting the environment
• Assistive devices
• Changing activities
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Risks for poor behavioral health
• Cumulative loss
• Cumulative disadvantage
• Poor health
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At risk
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Protective factors
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Protective factors—social support
Two pillars of aging well . . . One is love and the idea that other people matter. The second is finding a way of coping with life that does not push love away
(Vaillant, 2014)
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Protective factors
Social support system• Unconditional love and acceptance
• Reassurance
• Listening
• Tangible aid or assistance
• Advice (wanted)
(McQueen, 2012)
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Protective factors—engagement in activities meaningful to the individual
• Growth is lifelong
• Pleasure in life
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Protective factors – access to services
• Supporting social engagement
• Personal and community resources
• Health care
• Behavioral health care
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I’m grateful for . . .
• Family
• Friends
• Home
• Health
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I’m grateful for
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Acknowledgments
This training was developed by Portland State University on behalf of Oregon Health Authority, Health Systems Division
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Special thanks to:Interviewees:
Carole Beauclerk, Darlene Eckert, Dean Azule, Emily Guion, Emily Newberry, Joan Silver, Kathleen Nichols, Larry Cross, Lorraine Griffey, Peg Hackenbruck, Richard Wilde, Robert Hamilton, Sandra Trainer, Sherian Asher and Stephanie Montgomery
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Special thanks to:
CAVET Videography, Portland State University:
• Producer: Brian Grant
• Associate Producer: Leif Fuller
• Camera Operator: Nicole Marsh
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Special thanks to:Oregon Health & Science University EdCOMM:
• Manager, Creative Services: Larry Dlugas
• Photography: Jeff Ball, Aaron Bieleck and David Wakeling
• Videography: Jeff Ball, Steven Wong, Jr. and David Wakeling
• Editing: David Wakeling
Editing by Karen R. Jones
Narration by David Loftus
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This training was prepared by Portland State University
• Project Director: Diana White
• Project Co-director: Linda Dreyer
• Project Manager: Natasha Spoden
• Project Staff: Alan DeLaTorre, Aubrey Limburg, Julie Reynolds, Megan Rushkin and Sheryl Elliott
• Project Graduate Research Assistants: Candace Lewis Laietmark, Litxia Barrett and Lu Pang
• Project Staff Support by: LeAnne Fettig
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