Journal of Gerontological Social Work, 50(S1), 2008, pp.345-355.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
This paper summarises the findings of the systematic reviews of psychosocial interventions reported in this issue of the journal, identifying effective intervention approaches for physical health problems, mental health problems and particular social roles (end of life care, family carers, grandparent carers, people with developmental disabilities and their carers). Problems with psychosocial intervention research are noted, including the small size and methodological weakness of many studies, a failure to report the details of an intervention and its implementation, and lack of consensus over which outcomes should be measured. Future research studies need to be larger, more robustly designed and with long term follow-up. They also need to cover more diverse populations (e.g. ethnic minority groups) and more diverse topics in addition to the problems of functional decline. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
This paper summarises the findings of the systematic reviews of psychosocial interventions reported in this issue of the journal, identifying effective intervention approaches for physical health problems, mental health problems and particular social roles (end of life care, family carers, grandparent carers, people with developmental disabilities and their carers). Problems with psychosocial intervention research are noted, including the small size and methodological weakness of many studies, a failure to report the details of an intervention and its implementation, and lack of consensus over which outcomes should be measured. Future research studies need to be larger, more robustly designed and with long term follow-up. They also need to cover more diverse populations (e.g. ethnic minority groups) and more diverse topics in addition to the problems of functional decline. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
older people, outcomes, psychosocial intervention, research methods;
Health and Social Work, 33(2), May 2008, pp.133-143.
Publisher:
Oxford University Press
This study sought to identify the psychiatric, physical, and social services needs experienced by older adults with severe mental illness (SMI) and to examine factors influencing their experience of need and service provision adequacy. Seventy-five older adults with SMI were recruited from a community mental health centre in a large southern American city to participate in the study. The typical client experienced a need for care in 10 areas, with the greatest needs occurring in the areas of psychological pain, physical illness, social contacts, looking after the home, and daily activities. The total number of unmet needs ranged from zero to 10, with the typical client having an average of 2.3 unmet needs (SD = 2.4). The highest proportions of unmet needs were in the areas of social contact, benefits, sight or hearing difficulties, and intimate relationships. Linear hierarchical regression analyses revealed that clients with lower income, greater impairments in independent daily living skills, and higher levels of depression experienced increased needs for care. Older clients who lived in private homes or apartments had higher levels of depression, and those who required assistance in the areas of intimate relationships and benefits experienced higher levels of unmet needs. Research and practice implications are discussed.
This study sought to identify the psychiatric, physical, and social services needs experienced by older adults with severe mental illness (SMI) and to examine factors influencing their experience of need and service provision adequacy. Seventy-five older adults with SMI were recruited from a community mental health centre in a large southern American city to participate in the study. The typical client experienced a need for care in 10 areas, with the greatest needs occurring in the areas of psychological pain, physical illness, social contacts, looking after the home, and daily activities. The total number of unmet needs ranged from zero to 10, with the typical client having an average of 2.3 unmet needs (SD = 2.4). The highest proportions of unmet needs were in the areas of social contact, benefits, sight or hearing difficulties, and intimate relationships. Linear hierarchical regression analyses revealed that clients with lower income, greater impairments in independent daily living skills, and higher levels of depression experienced increased needs for care. Older clients who lived in private homes or apartments had higher levels of depression, and those who required assistance in the areas of intimate relationships and benefits experienced higher levels of unmet needs. Research and practice implications are discussed.
Subject terms:
needs, older people, severe mental health problems, unmet need;
Families in Society, 89(1), January 2008, pp.51-60.
Publisher:
The Alliance for Children and Families
Approximately 1 million older persons have a severe mental illness (SMI) and this number is expected to double in the coming decades. While research studies have examined the experiences of family members of younger persons with SMI, very little is known about caregivers of older SMI clients. This study examined the characteristics, burdens, and rewards of 60 caregivers of older SMI clients in the US using a modified version of family caregiver scales of Tessler, Fisher, & Gamache (1992). Hierarchical linear regression analyses indicated that increased client symptoms, higher levels of help provided, increased caregiver income, and knowledge about the care recipient’s diagnosis were predicative of caregiver burden. Decreased number of client symptoms, care recipient being female, and greater experience of the presence of God predicted caregiver rewards. Implications of these findings are discussed.
Approximately 1 million older persons have a severe mental illness (SMI) and this number is expected to double in the coming decades. While research studies have examined the experiences of family members of younger persons with SMI, very little is known about caregivers of older SMI clients. This study examined the characteristics, burdens, and rewards of 60 caregivers of older SMI clients in the US using a modified version of family caregiver scales of Tessler, Fisher, & Gamache (1992). Hierarchical linear regression analyses indicated that increased client symptoms, higher levels of help provided, increased caregiver income, and knowledge about the care recipient’s diagnosis were predicative of caregiver burden. Decreased number of client symptoms, care recipient being female, and greater experience of the presence of God predicted caregiver rewards. Implications of these findings are discussed.
Subject terms:
older people, severe mental health problems, stress, carers;
Journal of Gerontological Social Work, 58(3), 2015, pp.253-271.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with severe mental health problems (defined as schizophrenia, schizoaffective disorder, bipolar disorder, or major recurrent depression). The Stress-Process Model was used as a framework for conceptualizing constructs to be explored in the study. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient’s symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.
(Edited publisher abstract)
Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with severe mental health problems (defined as schizophrenia, schizoaffective disorder, bipolar disorder, or major recurrent depression). The Stress-Process Model was used as a framework for conceptualizing constructs to be explored in the study. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient’s symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.
(Edited publisher abstract)
Subject terms:
older people, severe mental health problems, carers, stress, social networks, depression;
Aging and Mental Health, 13(4), July 2009, pp.619-627.
Publisher:
Taylor and Francis
This study sought to examine the combination of formal and informal services supplied to older adults with severe mental illness, to assess the adequacy of services received, and to determine factors predictive of formal and informal service provision. A cross-sectional research design was employed. Seventy-five older adults diagnosed with a SMI were recruited through local community mental health centre. Data was collected through face-to-face interviews using the Camberwell Assessment of Needs for the Elderly. Clients most frequently received services from formal sources for psychiatric distress, physical health, information, and dangerous behaviour needs while informal sources provided the greatest amount of assistance for self-care, psychiatric distress, and money management needs. Appropriate assistance was most often not provided for benefits, sight/hearing, and incontinence. Formal services were predicted by group residence and dangerous behaviour, physical illness, medication, and daily activity needs. Assistance from informal sources was predicted by private residence, self-care, mobility, and money management needs. While formal and informal sources provided adequate services for certain client needs, over 70% of the clients did not receive the correct type of help for some of their needs. Greater communication between mental health care staff and informal caregivers, and the integration of aging network services, is essential for the adequate provision of care to older severely mentally ill (SMI) adults. Education and greater linkages among care providers are necessary so that all service providers are aware of and are able to appropriately respond to the complex multi-level needs experienced by older SMI adults.
This study sought to examine the combination of formal and informal services supplied to older adults with severe mental illness, to assess the adequacy of services received, and to determine factors predictive of formal and informal service provision. A cross-sectional research design was employed. Seventy-five older adults diagnosed with a SMI were recruited through local community mental health centre. Data was collected through face-to-face interviews using the Camberwell Assessment of Needs for the Elderly. Clients most frequently received services from formal sources for psychiatric distress, physical health, information, and dangerous behaviour needs while informal sources provided the greatest amount of assistance for self-care, psychiatric distress, and money management needs. Appropriate assistance was most often not provided for benefits, sight/hearing, and incontinence. Formal services were predicted by group residence and dangerous behaviour, physical illness, medication, and daily activity needs. Assistance from informal sources was predicted by private residence, self-care, mobility, and money management needs. While formal and informal sources provided adequate services for certain client needs, over 70% of the clients did not receive the correct type of help for some of their needs. Greater communication between mental health care staff and informal caregivers, and the integration of aging network services, is essential for the adequate provision of care to older severely mentally ill (SMI) adults. Education and greater linkages among care providers are necessary so that all service providers are aware of and are able to appropriately respond to the complex multi-level needs experienced by older SMI adults.
Subject terms:
needs, older people, service uptake, severe mental health problems, social networks, access to services, depression;
Journal of Gerontological Social Work, 52(1), January 2009, pp.17-31.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
This study examines the treatment efficacy of a mental health geriatric interdisciplinary team in Tennessee, which includes social workers, a psychologist, a clinical nurse specialist, a psychiatrist, case managers and a programme manager, all with geriatric training. The sample consisted of 69 community dwelling clients aged 55 or older with severe mental health problems defined as schizophrenia, schizoaffective disorder, bipolar disorder or major recurrent depression. The majority had major recurrent depression. The results show a reduction in depressive symptoms and psychiatric hospital admissions, and an increase in life satisfaction, at six-month follow-up. No changes were found in health status or in medical hospital admissions.
This study examines the treatment efficacy of a mental health geriatric interdisciplinary team in Tennessee, which includes social workers, a psychologist, a clinical nurse specialist, a psychiatrist, case managers and a programme manager, all with geriatric training. The sample consisted of 69 community dwelling clients aged 55 or older with severe mental health problems defined as schizophrenia, schizoaffective disorder, bipolar disorder or major recurrent depression. The majority had major recurrent depression. The results show a reduction in depressive symptoms and psychiatric hospital admissions, and an increase in life satisfaction, at six-month follow-up. No changes were found in health status or in medical hospital admissions.
Subject terms:
integrated services, older people, outcomes, severe mental health problems, community health care, evaluation;
Journal of Gerontological Social Work, 50(S1), 2008, pp.215-241.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Although the prevalence of alcohol abuse is generally less among older than younger people in the USA, it poses particular risks for increased morbidity and mortality among older people. It is also expected to increase as the population ages. However, little attention has been paid to the development and evaluation of interventions for this population. This systematically conducted review identifies nine outcome studies, finding that promising interventions include those that are age-specific, less confrontational and cognitive-behavioural in approach. The paper concludes with a ‘treatment resource appendix’ directed at American social workers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Although the prevalence of alcohol abuse is generally less among older than younger people in the USA, it poses particular risks for increased morbidity and mortality among older people. It is also expected to increase as the population ages. However, little attention has been paid to the development and evaluation of interventions for this population. This systematically conducted review identifies nine outcome studies, finding that promising interventions include those that are age-specific, less confrontational and cognitive-behavioural in approach. The paper concludes with a ‘treatment resource appendix’ directed at American social workers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Journal of Gerontological Social Work, 47(3/4), 2006, pp.173-186.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
This American study sought to provide data regarding the use of infusion of gerontological materials throughout curriculums to enhance students' attitudes toward older adults, their knowledge of aging-related issues, and their perceptions of gerontological social work. A quasi-experimental design was used to compare outcomes for graduate social work students who were and those who were not exposed to gerontological infusion. Results indicated that exposed students experienced a greater improvement in their view of aging-related career opportunities and in their belief in the importance of gerontological social work. Treatment group students also showed greater gains in self-rated aging knowledge. Both treatment and control group students had significant gains in a test of aging-related knowledge. Pedagogical implications are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
This American study sought to provide data regarding the use of infusion of gerontological materials throughout curriculums to enhance students' attitudes toward older adults, their knowledge of aging-related issues, and their perceptions of gerontological social work. A quasi-experimental design was used to compare outcomes for graduate social work students who were and those who were not exposed to gerontological infusion. Results indicated that exposed students experienced a greater improvement in their view of aging-related career opportunities and in their belief in the importance of gerontological social work. Treatment group students also showed greater gains in self-rated aging knowledge. Both treatment and control group students had significant gains in a test of aging-related knowledge. Pedagogical implications are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
older people, social work education, student social workers, ageing, attitudes, curriculum development;
CUMMINGS Sherry M., BRIDE Brian, RAWLINS-SHAW Ann M.
Journal article citation:
Journal of Evidence-Based Social Work, 3(1), 2006, pp.79-99.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
The purpose of this article is to enhance social work practitioners and researchers' understanding of the nature of elder alcohol abuse, the needs of elders with alcohol abuse disorders, and the availability of effective treatment strategies by reviewing the epidemiological and outcomes research literatures related to alcohol abuse and the elderly. The few empirical studies that examine outcomes associated with the treatment of elderly substance abusers reveal positive outcomes, especially when “age-specific,” cognitive-behavioural, and less confrontational treatment approaches are employed. The authors highlight the need for further research concerning the nature of alcohol abuse among the elderly and the impact of specific alcohol treatment strategies on older adults. Such research should consider the needs and experiences of specific sub-populations of elders such as women, minorities, and those with late onset disorders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
The purpose of this article is to enhance social work practitioners and researchers' understanding of the nature of elder alcohol abuse, the needs of elders with alcohol abuse disorders, and the availability of effective treatment strategies by reviewing the epidemiological and outcomes research literatures related to alcohol abuse and the elderly. The few empirical studies that examine outcomes associated with the treatment of elderly substance abusers reveal positive outcomes, especially when “age-specific,” cognitive-behavioural, and less confrontational treatment approaches are employed. The authors highlight the need for further research concerning the nature of alcohol abuse among the elderly and the impact of specific alcohol treatment strategies on older adults. Such research should consider the needs and experiences of specific sub-populations of elders such as women, minorities, and those with late onset disorders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Extended abstract:
Author
CUMMINGS Sherry M.; BRIDE Brian; RAWLINS-SHAW Ann M .;
Title
Alcohol abuse treatment for older adults: a review of recent empirical research.
Journal citation/publication details
Journal of Evidence-Based Social Work, 3(1), 2006, pp.79-99.
Summary
The seven outcome studies identified for the formal review reported in this paper reveal positive effects, especially when age-specific, cognitive-behavioural and less confrontational treatment approaches are used. However, the evidence base is extremely limited, and more research is needed on the nature of alcohol abuse among older people and the impact of treatment on specific sub-populations such as women and people from minority ethnic groups. All of the research reviewed appears to be from the USA .
Context
Social work practitioners will increasingly confront older people with alcohol disorders as the population ages and the aim of this paper is to enhance practitioners' understanding of these disorders and the availability of effective treatment strategies. It covers a considerable amount of literature in addition to the few studies that are formally reviewed, to provide an insight into the consequences of alcohol abuse for morbidity and mortality among older people, the prevalence of abuse and the kinds of treatment approaches that are in use.
Methods
What sources were used?
The following databases were searched: ETOH [the now archived Alcohol and Alcohol Problems Science Database, 1977-2003, produced by the US National Institute on Alcohol Abuse and Alcoholism]; PsycINFO; Sociofile [the former name of Sociological Abstracts]; PubMed; and AgeLine.
What search terms/strategies were used?
No details are given, apart from a date limitation to material from 1980 onwards.
What criteria were used to decide on which studies to include?
Eligible studies specifically addressed the outcomes of interventions for older adults with alcohol abuse or dependence disorders. No specific definition of 'older adult' was established, and studies that identified subjects as 'old' or 'older' were selected.
Who decided on their relevance and quality?
No details are given. The authors note that the vast majority of the studies they identified were descriptive and did not consider the outcomes of interventions.
How many studies were included and where were they from?
Seven studies were found, summarised in Table 2 which gives details of study populations, sample sizes (16-137 individuals), gender, race, treatment and outcomes. They all appear to be from the USA .
How were the study findings combined?
The synthesis is narrative in nature, with each study described in turn.
Findings of the review
On the basis of the very limited number of outcome studies identified, the authors find that interventions with older alcohol abusers produce positive outcomes including abstinence (four studies), a reduction in alcohol use (two studies) and improvements in general health (one study). Older people seem to do best when treated with a cognitive-behavioural approach (one study), are more likely to comply with treatment and have better outcomes when treated in an older person-specific programme (one study), and have better outcomes when treated in a more supportive, less confrontational environment (one study).
Authors' conclusions
While the number of studies identified in this review is very small, they 'offer important data suggesting the beneficial response of older persons to alcohol treatment programs'. More research, however, is needed to confirm the results of these studies, explore which components of interventions are essential to their success, and extend studies to cover women and those from minority ethnic groups. The adoption of clear definitions of 'abuse' and 'elderly' is also necessary. In the studies reviewed 'light' alcohol use was deemed acceptable by some researchers, while others defined any alcohol use as abuse. Participants ranged from 45 to 91, and people within this span of ages clearly have very different outlooks and face different kinds of challenge in their lives.
Implications for policy or practice
No specific implications are discussed.
Subject terms:
literature reviews, older people, outcomes, treatment, therapy and treatment, alcohol misuse;
Journal of Gerontological Social Work, 26(3/4), 1996, pp.83-98.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
The needs and experiences of caregivers of persons with early Alzheimer's Disease are often complex and intense. These challenges are heightened for spousal caregivers who must contend with the dissolution of their primary relationship and expectations of the future based upon that relationship. The article describes a psychoeducational support model for caregiving spouses of early Alzheimer's patients which has been used in the United States. Outlines the format of the groups, discusses the major themes that have emerged for the caregiving spouses and provides some case examples. Goes on to discuss recommendations for those working with caregiving spouses.
The needs and experiences of caregivers of persons with early Alzheimer's Disease are often complex and intense. These challenges are heightened for spousal caregivers who must contend with the dissolution of their primary relationship and expectations of the future based upon that relationship. The article describes a psychoeducational support model for caregiving spouses of early Alzheimer's patients which has been used in the United States. Outlines the format of the groups, discusses the major themes that have emerged for the caregiving spouses and provides some case examples. Goes on to discuss recommendations for those working with caregiving spouses.