Geriatric Mental Health Care: A Treatment Guide for Health Professionals / Edition 1

by Gary J. Kennedy MD

Overview

This essential guide is designed for mental health practitioners and primary care providers without advanced training in geriatric psychiatry. Gary J. Kennedy sets forth a clear framework for understanding the interplay of medical, psychological, and social factors in frequently encountered problems among older adults. Clear guidelines are delineated for assessing and treating such conditions as depression and anxiety, dementia, psychosis and mania, sleep disturbances, personality and somatoform disorders, substance abuse, and suicidality. Throughout, the book focuses on ways to sustain seniors' independence and overall quality of life while enhancing their adaptive capacities.

Winner—American Journal of Nursing Book of the Year Award (2000)

See also the author's Geriatric Depression: A Clinical Guide, which distills the best available interventions for depression in older adults in a highly accessible format.

Product Details

ISBN-13:	9781572307452
Publisher:	Guilford Publications, Inc.
Publication date:	11/02/2001
Edition description:	New Edition
Pages:	347
Product dimensions:	6.00(w) x 9.00(h) x (d)

About the Author

Gary J. Kennedy, MD, is Professor of Psychiatry and Behavioral Science at Albert Einstein College of Medicine and Director of the Division of Geriatric Psychiatry and the Psychogeriatric Fellowship Training Program at Montefiore Medical Center in Bronx, New York. He is also Supervising Psychiatrist of the Geriatric Unit at Bronx Psychiatric Center. More than 30 psychiatrists have completed geriatric training under his direction. Dr. Kennedy's research and teaching have focused on cardiac arrhythmias, the epidemiology of depression and dementia, and mental health care in nursing homes and in the community.

Table of Contents

1.	Introduction to the Geriatric Imperative	1
	Core Concepts from Sociology and Clinical Sciences	2
	The New Psychopharmacology: Burdens and Benefits	10
	Attributes of Successful Geriatric Practice	15
	References	16
2.	Depression and Anxiety	19
	Assessment	19
	Symptom Identification, Screening for the Disorders	20
	Geriatric Syndromes, Depression, and Anxiety	21
	Comorbidity of Mental and Physical Disorders	22
	Anxiety Disorders	23
	Suicide	25
	Comprehensive Treatment of Depression and Anxiety Disorders	25
	References	38
3.	The Dementias	44
	Dementia Defined	44
	Epidemiology	45
	Genetic and Other Risk Factors	45
	Diagnostic Criteria and Procedures	46
	Differential Diagnosis	47
	Cognitive Assessment	52
	Assessment of Functional Impairment	55
	General Treatment Considerations	56
	Medications to Palliate Cognitive Impairment	57
	Environmental Modifications	62
	Management of Behavioral and Psychological Signs and Symptoms	63
	Specific Problem Behaviors and Symptoms	64
	Medications to Lessen Behavioral and Psychological Disturbances	71
	Caregiver Burden and Dysfunctional Family Dynamics	73
	Practitioner as De Facto Guardian and Other Medical--Legal Issues	74
	Management of Financial Resources	75
	Preparations for End-of-Life Care	76
	Summary	76
	References	77
4.	Psychosis and Mania	84
	Achieving and Sustaining the Alliance	84
	The Schizophrenias	89
	Delusional Disorder	91
	Mania	91
	Antipsychotics and the Avoidance of Movement Disorders	94
	Electroconvulsive Therapy for Mania or Psychosis	99
	Summary	99
	References	100
5.	Sleep Disturbances	103
	Assessment	103
	Treatment	107
	Summary	112
	References	112
6.	Personality, Somatoform, and Pain Disorders	114
	Personality Disorders	114
	Somatoform and Pain Disorders	121
	References	125
7.	Individual Psychotherapies for Older Adults	127
	Arguments for Psychotherapy in Late Life	127
	Assessment for Psychotherapy	130
	Brief Psychodynamic versus Supportive Therapy	131
	General Principles of Cognitive-Behavioral Therapy	133
	Interpersonal Therapy for Late-Life Depression	141
	Life Review or Reminiscence Therapy	143
	Problem-Solving Therapy	144
	Treatment of Caregiver Burden and Depression	144
	Bereavement Therapy	148
	Summary	151
	References	151
8.	Adapting Principles of Marital, Group, and Family Therapy to the Needs of Older Patients	155
	Marriage or Couple Therapy with Older Adults	155
	Models	157
	Group Therapy with Older Adults: General Considerations	160
	Family Work	165
	Work with Ethnic Elders, Emigres, and Religious Minorities	168
	Preparing for Genetic Counseling	169
	Summary	170
	References	170
9.	Sexuality	175
	Myths about Sex and Aging	175
	Realities	176
	The Genesis of Late-Life Sexual Dysfunction	179
	Evaluation	181
	Management of Sexual Dysfunction	182
	Sex in the Nursing Home	188
	Summary	188
	Suggested Reading for Patients	189
	References	189
10.	Elder Abuse, Neglect, and Self-Injurious Behaviors	192
	Definitions	192
	Problem with Reports of Elder Mistreatment	193
	Detection	197
	Intervention	200
	Summary	201
	Appendix	202
	References	205
11.	Alcohol and Substance Abuse	208
	Prevalence of Alcohol Problems among Older Adults	208
	Prevalence of Nonalcohol Substance Abuse in Late Life	209
	Pharmacodynamics of Alcohol in the Aged	210
	Uncertain Diagnostic Criteria	211
	Symptom Presentation of Alcohol Abuse in Old Age	212
	Detection and Screening	213
	Assessment	217
	Treatment	218
	Presentation of a Case	222
	Summary	225
	Books for Patients and Families	225
	References	225
12.	Recognition and Reduction of Suicide Risk	229
	Trends in the Prevalence of Late-Life Suicide	230
	Gender, Race, and Social Factors	231
	Historical and Generational Effects	232
	Methods of Death	232
	Physical Illness	233
	Excesses of Modern Medicine	234
	Attitudes of Older Adults Regarding Suicide	234
	The Neurobiology of Suicidality	235
	Mental Disorders and Suicide	235
	Personality and Neuropsychology	236
	The Clinical Assessment of Suicidal Thought and Behavior	236
	Management of Acute Suicidal Risk	238
	Management of Chronic Suicidal Risk	240
	When Prevention Fails	240
	Public Policy and Prevention	241
	Summary	243
	References	243
13.	Mental Health Consultation in the General Hospital, Home, or Nursing Facility	248
	Patterns of Mental Health Consultation	248
	Models and Methods	249
	Mental Health Care in Nursing Homes	262
	Consultation to Certified Home Health Agencies: How to Make a House Call	267
	Summary	276
	References	277
14.	Legal and Ethical Issues	282
	Modern History of the Doctor--Patient Relationship	282
	Autonomy, Abandonment, and the Sanctity of Life	283
	Assessment of Decision Making: Competence or Capacity?	286
	Other Bioethical Issues of Concern	299
	Medical Futility: Who Decides, Who Defines?	302
	Physician-Assisted Suicide	304
	How to Conduct a Bioethics Consultation	307
	Summary	310
	Appendix	310
	References	315
15.	Advice on Exercise and Nutrition	318
	Nutrition and Exercise as Primary and Secondary Prevention	318
	Dietary Intervention	319
	Gaining Weight	322
	Treatment of Overweight and Obesity	323
	Constipation	324
	Healthy Exercise for Seniors	324
	Summary	328
	Books on Exercise and Nutrition for the General Reader	329
	References	329
	Index	333

Interviews

Primary care providers and mental health practitioners; graduate students and trainees in geriatric medicine, general psychiatry, social work, nursing, clinical psychology, and gerontology. May serve as a text in graduate-level courses and clinical practica.

Editorial Reviews

"It is noteworthy that Dr. Kennedy gives special consideration to the complexities of providing consultation in nursing homes, on home visits, and to other health care agencies. Specific guidance on navigating this unchartered territory is both practical and valuable....Geriatric Mental Health Care is a timely endeavor written by one of the leading educators in geriatric psychiatry to guide and instruct health care professionals at every level in working with the elderly."

Psychiatric Services

"A useful reference for the student and generalist concerned with the life problems and mental health of elders. For a single author to be able to encompass this body of knowledge is remarkable, and Kennedy does it well."

American Journal of Psychotherapy

"In a clearly written, practical guidebook for practitioners, Dr. Kennedy combines a wealth of published information with his own considerable clinical experience in treating older individuals....I strongly recommend this volume for the practicing psychiatrist who is working with older patients; the information presented will be most helpful."—The Journal of Clinical Psychiatry

"...this is a useful reference for the student and generalist concerned with the life problems and mental health of elders. For a single author to be able to encompass this body of knowledge is remarkable, and Kennedy does it well."—American Journal of Psychotherapy

"...a timely, thorough and well-written guide for primary care and mental health professionals who do any work with older adults. It can also be used by students and trainees across disciplines as a reference text for mental health issues, including evaluation and treatment of disorders, among persons. The breadth of topics covered in this book makes it a unique contribution to the field. Throughout the text, close attention is paid to the delicate interaction between biological, psychological, and social variables that may contribute to morbidity in elderly persons....It is noteworthy that Dr. Kennedy gives special consideration to the complexities of providing consultation in nursing homes, on home visits, and to other health care agencies. Specific guidance on navigating this unchartered territory is both practical and valuable....Geriatric Mental Health Care is a timely endeavor written by one of the leading educators in geriatric psychiatry to guide and instruct health care professionals at every level in working with the elderly....The book is highly recommended to any clinician or caretaker seeking comprehensive and easily accessible information about geriatric mental health care."—Psychiatric Services

"Gary Kennedy, one of our leading geriatric psychiatrists, brings his thoughtful scholarship and breadth of clinical experience to this endeavor. At once focused and comprehensive, chapters provide concise overviews of the main areas of geriatric psychiatry—such as late-life depression—as well as useful reference material. Perhaps the greatest strengths of the book, however, lie in its coverage of lesser-understood topics such as elder abuse/neglect and personality disorders. This volume will be a welcome addition to the bookshelf of all generalist physicians and mental health professionals working with older adults."—Dan Blazer, MD, PhD, J.P. Gibbons Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center

"On any given day, people over 65 constitute the majority of patients seen by a range of practitioners. In addition to diseases and functional disorders, a substantial portion of these patients have cognitive disorders and psychopathology. Yet few nongeriatric clinicians are prepared to recognize, assess, and treat these conditions. This valuable text will improve the clinical care and support that generalist practitioners can offer to older people and their caregivers"—Mathay Mezey, EdD, RN, FAAN, Independence Foundation Professor of Nursing Education and Director, The Hartford Institute for Geriatric Nursing, New York University Division of Nursing

"This book is clearly written and concise yet addresses a wide range of practical issues that the primary care provider is likely to encounter when caring for older adults. It is evidence based and well referenced. The tables target the major differences among psychotherapeutic agents that would allow one to individualize therapy based on underlying conditions and comorbidities. I highly recommend this book to all providers of health care to older adults."—Rosanne M. Leipzig, MD, PhD, Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY

"This is an extremely readable overview whose scope goes beyond psychopathology in its usual sense. Every chapter also discusses the familial and social contexts of mental distress, making the book relevant for many types of professionals, including nonpsychiatric physicians, psychologists, nurses, social workers, administrators, and others who work with older people. Kennedy pays full attention to scientific evidence and the complexity of the issues while keeping the book focused and succinct. The case examples are very useful for everyday practice, as are tables providing quick reviews of topics as diverse as pharmacologic treatments for depression, decision-making competence, and types of sleep disorders."—M. Powell Lawton, PhD, Philadelphia Geriatric Center, Philadelphia, PA

From the Publisher

4 Stars! from Doody

Written and edited by a clinician-researcher in geriatric psychiatry, this comprehensive book is an excellent guide for managing mood, psychotic, and cognitive disorders of the elderly. The purpose, according to the author, is to provide a concise approach to geriatric conditions for the clinician already familiar with basic diagnosis and treatment of mental illness. In addition, he hopes to instruct the reader on how to work with the elderly, their families, and the rest of the care team. The author has succeeded in these goals with a very readable and up-to-date book. The intended audience, according to the author, is students and trainees in nursing, social work, psychology, and medicine, as well as practicing clinicians, managed care administrators, elder care managers, ethicists, and even lawyers! The first chapter is an overview of the field, and the author emphasizes medicine, sociology, and psychology. In the remaining chapters he deals with the various clinical problems in geriatric psychiatry including depression and anxiety, dementia, psychosis and mania, sleep disturbances, personality, somatoform and pain disorders, sexuality, elder abuse, neglect, self-injurious behaviors, alcohol and substance abuse, and suicide. There are also useful chapters on legal and ethical issues, exercise and nutrition, consulting to nursing homes, and psychotherapy. Each chapter ends with contemporary and pertinent references and there is a helpful index at the end of the book. This is a valuable contribution to the field. Any clinician who diagnoses and treats elderly patients with psychiatric problems would benefit from reading and referring to this book.

Michael J. Schrift

For mental health practitioners, primary care providers, and other health professionals without advanced training in geriatric psychiatry, Kennedy (psychiatry and behavioral science, Albert Einstein College of Medicine) makes detailed recommendations for managing the emotional, behavioral, and cognitive problems that are most frequently encountered in clinical practice with older adults. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Booknews

Reviewer: Michael Schrift, DO (University of Washington School of Medicine)
Description: Written and edited by a clinician-researcher in geriatric psychiatry, this comprehensive book is an excellent guide for managing mood, psychotic, and cognitive disorders of the elderly.
Purpose: The purpose, according to the author, is to provide a concise approach to geriatric conditions for the clinician already familiar with basic diagnosis and treatment of mental illness. In addition, he hopes to instruct the reader on how to work with the elderly, their families, and the rest of the care team. The author has succeeded in these goals with a very readable and up-to-date book.
Audience: The intended audience, according to the author, is students and trainees in nursing, social work, psychology, and medicine, as well as practicing clinicians, managed care administrators, elder care managers, ethicists, and even lawyers!
Features: The first chapter is an overview of the field, and the author emphasizes medicine, sociology, and psychology. In the remaining chapters he deals with the various clinical problems in geriatric psychiatry including depression and anxiety, dementia, psychosis and mania, sleep disturbances, personality, somatoform and pain disorders, sexuality, elder abuse, neglect, self-injurious behaviors, alcohol and substance abuse, and suicide. There are also useful chapters on legal and ethical issues, exercise and nutrition, consulting to nursing homes, and psychotherapy. Each chapter ends with contemporary and pertinent references and there is a helpful index at the end of the book.
Assessment: This is a valuable contribution to the field. Any clinician who diagnoses and treats elderly patients with psychiatric problems would benefit from reading and referring to this book.

Doody's Review Service