Читать книгу Helping Relationships With Older Adults - Adelle M. Williams - Страница 60

Older adults typically underutilize mental health services, which may be a result of interacting biases. One reason for this is older adults’ denial of problems because of feared social stigma or the generational psyche (Ronch & Maizler, 1977) that casts a shaming and critical eye on the “mentally ill” as weak, crazy, or morally inferior. The stigma of mental difficulties reflects and is reflected in social attitudes and the way society relegates these problems to subordinate status in health coverage, a powerful synergy for mutual disincentive on the part of providers and prospective consumers. Additionally, older adults feel that they should not share private matters with others outside of the family. They are a very heterogeneous population, and many grew up in an era where personal events and unpleasant occurrences remained within the family environment. Sharing personal accounts was negatively viewed, and therefore counseling was not viewed favorably, because it occurred outside the realm of the family.

Guided Practice Exercise 2.6 challenges the mental health counselor to diminish some longstanding beliefs regarding sharing private matters to persons other than family members. Counselors will need to become astute in working with reluctant clients who may not believe in the mental health system or the effectiveness of counseling services.

Guided Practice Exercise 2.6

Elderly individuals have been taught to maintain private matters within their family systems. This belief interferes with their ability to access the services of mental health counselors. As a new professional, how would you address the reluctance to pursue counseling services? What specific strategies would you employ? What resources would you need to increase their level of involvement? What information, skills, or abilities would you need to cultivate to work effectively with elderly clients?

Other causes for the underutilization of mental health services fall on mental health professionals. Mental health providers may avoid the aging client partially because of ageist myths, gerontophobia, or ageist attitudes toward older people, and lack of expertise. Sometimes professionals need to identify the signs and symptoms of emotional and psychological problems when they are presented with older clients.

Finally, barriers to access of services may play a role, such as cost and location. Current systems are suboptimal due to inadequate coordination and competing priorities between primary care, mental health, and aging service providers; funding and reimbursement problems; health care models oriented to acute medical illnesses of younger people; the role of managed care; and a shortage of trained providers in the medical and mental health arenas. Additional contributions to barriers of appropriate service include gaps in service that reflect a view of people as disparate diagnoses or unrelated needs and the lack of an adequately powerful consumer voice (Ronch & Goldfield, 2003).

When these barriers are removed and older clients receive the help that they need, they can lead happy, healthy lives. Case Illustration 2.4 shows the benefits that occur when older adults overcome their fear of practitioners and the practitioners collaborate for the bettering of their client. In this case, the loss of a spouse caused a depressive episode that was effectively treated with a combination of an antidepressant and individual counseling sessions.

Case Illustration 2.4

In the 4 months since the unexpected death of her husband of 48 years (married at age 20), Mrs. Jones has lost interest in all the activities that she and her husband enjoyed together. She has lost weight and sleeps irregularly, complaining of early morning awakening and difficulty falling asleep. She has difficulty concentrating and has no energy to do even the most basic tasks at home. Her adult children are alarmed and take her to see Dr. Zoy, a geropsychiatrist. Once evaluated, Dr. Zoy diagnoses her with depression and prescribes a low-dose antidepressant to be taken at night, which would be titrated upward as necessary.

Mrs. Jones discontinues her medications after one week, complaining that she feels “funny” and dizzy and is thirsty all of the time. Dr. Zoy meets with her and educates her on the benefits and side effects of the antidepressant and encourages her to comply with her medication regimen. He also refers her to a counselor within his practice who is trained in issues related to older persons for individual counseling sessions. After several months, Mrs. Jones sees the benefits of the medication and counseling sessions. She feels back to her old self, with a little sadness from time to time. She is now actively involved in her local community, interacting positively with family and friends, and eating a well-balanced diet and exercising regularly. She feels as though a burden has been lifted from her shoulders and now does not delay doing anything she wants to do.

Mrs. Jones is a baby boomer who now feels that she has the time and resources to explore various cultures by traveling to different countries. She feels that age 68 is entirely too young to be unproductive and plans to pursue her bachelor’s degree in psychology on a part-time basis. She’s also interested in developing a career, fully understanding she is getting off to a late start. Her excitement and enthusiasm is contagious, and she is fully supported by her family and friends.

At present, managed care is the most prevalent payer model in the health care arena. Called “managed cost” by some of its critics, it has been troubled by managed Medicare debacles and a failure to deliver on preventive services that address the unique, interrelated health care (physical and mental) needs of the aging (Ronch & Goldfield, 2003). Limits on mental health benefits combine with an inadequate network of expert providers to limit access for those aging people in need of state-of-the-art care. As these models confront their economic and conceptual limits, the number of aging people continues to grow rapidly. The result is increasing pressure on the current system of care that appears to be unprepared to answer the call for the health- and wellness-oriented system that would likely be the most beneficial and least costly in the future (Ronch & Goldfield, 2003). Additionally, public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care (Karel, Gatz, & Smyer, 2012).

In the acute care arena, older people turn first to their primary care providers when they have a mental health problem. More than 50% of those who seek mental health care receive it from primary care physicians, because it carries fewer stigmas than going to a mental health provider, insurance plans encourage use of the primary care provider, and the care is usually more accessible (Karel et al., 2012; Ronch & Goldfield, 2003). However, many primary care providers are not adequately trained in mental health problems of the aging and tend to use psychotropic drugs as their first or only line of treatment. Pressures from managed care economics also result in briefer physician visits, often averaging 8 minutes in duration. Also because of their coexisting physical conditions, older adults are significantly more likely to seek and accept services in primary care versus specialty mental health care settings (Institute of Medicine [IOM], 2012). More desirable collaborative service models that coordinate mental and physical health services in primary care are being investigated (Ronch & Goldfield, 2003).

While the baby boomers were growing up, the needs of these young families were a high priority in community development, with particular concern for family-friendly housing, parks, and schools. Now, their needs are shifting. Most baby boomers would like to stay in their own homes, or at least in their own communities, as they age. Nearly three-quarters of all respondents of an AARP survey felt strongly that they want to stay in their current residence as long as possible (Bayer & Harper, 2009). The image that most elders will move to a retirement village away from their communities is the exception rather than the rule. Most people will not have the resources or the inclination to move to Florida or its equivalent (the Sunbelt states); therefore, communities cannot rely on “exporting” to meet the needs of an aging population. If communities want to be successful in caring for their aging population, they will have to make significant, yet feasible, changes in housing, health care, and human services (Knickman & Snell, 2002).These changes can create stronger communities with healthy, long-living seniors.