Caring for the Aging Patient
While the elderly are, in many respects, no different than their younger counterparts, there are dynamics in the aging process in Western culture that create subtle issues that are easily overlooked. Frequently, elderly patients are just written off as old and/or senile because neither caregiver nor elder recognize the deeper causes of the problems. Figuring out the root of aging patients' odd behavior and the reasons they act the way they do is a crucial factor in changing the environment within nursing homes, assisted living facilities, and even hospital and home-care settings. Recognition of these issues and properly addressing them improves the efficacy of treatment.

In this one-day seminar, Dr. Nygard will discuss common issues and possible psychiatric syndromes in the elderly patient. He will look at the often unrecognized influences of our media and culture on health care and elders' self-fulfilling prophecies for their behavior. Cognitive rehabilitation for dementia will be covered as well as alternative models for long-term care, such as the Eden Alternative and Green Houses. Participants will leave this seminar with the knowledge they need to immediately incorporate better treatment and understanding of their elderly patients.

Course Content

PREVALENCE OF PSYCHIATRIC DISORDERS

IN THE ELDERLY

• Aging in the United States vs. other cultures
• The myth of retirement
•           "Health Prisons"
  • environments that take over and enforce healthy lifestyles
• Incidence of disorders

UNIVERSAL STRATEGIES

• Validation of their point of view
• The Therapeutic Alliance
• Establishing your role as problem-solver: changing roles from that of "health enforcer"

DEPRESSION

• Subtle signs of depression
  • boredom
  • loss of interest
  • decreased energy
• Differential diagnosis with uncomplicated dementia
• Treatment
  • active empathetic listening
  • restructuring roles and priorities
  • mindfulness
  • anhedonia vs. dyshedonia: recognition of reduction vs. complete loss of                      pleasure

            -           partnering with psychotropics: synergistic strategies

SIGNS OF ANXIETY 

• Somaticization
  • withdrawal of activity
  • refocusing outside of the narrow world of symptoms
• Restlessness
  • substitution of meaningful activity
  • repeated reassurance and interpretation of meaning of behaviors
  • helping them change gears to "being rather than doing"
  • tolerance for altered level of activity: is this behavior harmful or merely odd?
• Call Light Mania
  • behavior management and "catching them being good"
  • logging and tracking response time
• Control hunger
  • changing from a medical model to a resident-centered model of care

FEELINGS OF LOSS

• Preoccupation with absent relationships
• Perseveration of past achievements
  • cognitive reframing onto value of being present
  • exploring for acquired wisdom
• "Just looking for attention"
  • staff framing of behavior toward meeting the need behind the behavior
• Sexual inappropriateness
  • staff awareness of possible misinterpretable cues
  • consistent confrontation
• Treatment
  • empathy
  • reframing
  • finding alternative bonds

FAMILY CONTROL ISSUES

• "Nothing is good enough for Mom"
• "She can't do that anymore"
• Role reversal

WAITING FOR JESUS ("I'M READY ANY

TIME, MAYBE TONIGHT")

• Differential diagnosis with depression
• Loss of meaning
• Loss of opportunities to give to others
• Feeling "treated" vs. "cared-for"

THE PLAGUES OF LONG-TERM CARE

• Antidotes
• "Prison break"
  • moving away from the "Health Prison" model of controlling patients
• The need for rehabilitation mindset
• Cognitive rehabilitation for dementia
• We can manage more problems than we think

ALTERNATIVE MODELS FOR

ELDER CARE          

• Eden Alternative
• Pioneer Network
• Green Houses
• Summit Model

HOSPICE CARE

• Listening and acceptance
• Assistance with resolving old issues
• Balancing assistance with dying and openness to improvement

HOSPITAL CARE

• Signs of giving in to premature debilitation
• Crucial need for starting rehabilitation ASAP
• Delirium and temporary dementia

Guardianship and power of attorney