Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.
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This chapter focuses on using humanistic sandtray as a structured play therapy intervention with clients aged 9 years and older. Humanistic sandtray therapy is a type of play therapy that can be used with clients of many ages, from preadolescents to older adults. This approach to sandtray emphasizes the primacy of the therapeutic relationship and views the relationship as the curative factor in therapy. In sandtray, therapists and clients benefit from the symbolic nature of the experience because it increases safety and provides clients with a metaphorical and indirect mode of expression. The chapter illustrates the case example to help clients go deeper into their inner experiencing and awareness so that they might move in the direction of becoming a more fully functioning person. Fully functioning people are moving in the direction of increasingly trusting their inner experiencing and becoming open to a wide range of emotions.
Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.
This chapter presents specific issues faced by older adults in response to adaptations to chronic illness and disability. Some individuals have congenital disabilities and others acquire a disability early in life and are able to adjust fairly easily, aging with their disability. On the other hand, some individuals acquire a disability later in life and may experience great difficulty making the adjustments to their condition. The chapter presents information on the age-related concerns of older adults, components and perceptions of aging, assessment issues associated with older adults, vocational interests, and death and dying perspectives. It also discusses the implications for service delivery in the context in which older adults are served along with laws and regulations that apply to the population. Aging and geriatric persons often utilize a variety of services from multiple entities (e.g., social, legal, medical, financial, and counseling).
This chapter discusses the major mental health disorders experienced by older adults, identifies the most effective counseling approaches and psychotropic medications used to address the mental health needs of older adults, and provides an overview of best practice counseling and treatment interventions used to address the mental health needs of older adults. In an overview of the literature regarding major depression and dysthymia, Zalaquett and Stens examined the effectiveness of four commonly used individual therapies for treating older adult depression: cognitive behavior therapy (CBT), interpersonal therapy (IPT), brief dynamic therapy (BDT), and reminiscence therapy (RT) and life review (LR) therapy. Counselors can develop brief checklists to assist clients in tracking their symptoms. Counselors should also educate themselves about the signs of excessive alcohol and substance abuse, noting that some medical conditions may have similar symptoms to drug or alcohol abuse.
The field of counseling is an exciting and challenging career choice. It is a profession that has a prolific history of enabling person-centered counseling approaches for individuals, couples, partners, and families, and facilitates therapeutic services for children, adolescents, adults, and older adults. This book offers an excellent resource for graduate-level coursework that relates to an orientation to the counseling profession, professional issues, and special topic seminars, as well as other counseling-related coursework. It provides both contemporary insight and practical strategies for working with the complexity of real-life issues related to assessment, diagnosis, and treatment of diverse clients and their families. The book provides professionals with chapters organized into the 10 CACREP and CORE content areas that address the awareness, knowledge, and skills required to work with children, adolescents, individuals, groups, couples, families, and persons from diverse cultural backgrounds. The content areas are: professional counseling identity, ethical and practice management issues, case management and consultation issues, multicultural counseling awareness, counseling theories and techniques, career counseling and human growth, assessment and diagnosis, counseling couples, families, and groups, counseling specific populations, and contemporary issues in counseling.
- Go to article: Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.
Old age brings with it unique challenges in diagnosis, treatment, and care; dementia complicates these issues even more. Improving the management and care of persons with dementia has positive implications for patients, caregivers, and physicians alike. Two types of secondary complications can be analyzed in relation to dementia: conditions that arise outside of the dementia and then conditions that appear to develop due to the neurological degeneration inherent in dementia. Examples of psychiatric complications include depression, anxiety, and psychosis. Medical problems consist of issues such as stroke, cardiovascular problems, cancer, infections, orthopedic issues, diabetes, nutritional disorders, vision and hearing problems, as well as general pain. The high comorbidity of dementias with other psychiatric and medical issues can complicate the diagnosis and treatment of patients with dementia. Issues in the central nervous system (CNS) have long been looked at as possible predictors of dementia.
- Go to article: The Lived Experience of Community-Dwelling Older Adults With Chronic Obstructive Pulmonary Disease (COPD) in a Rural Community in Northern Thailand
The Lived Experience of Community-Dwelling Older Adults With Chronic Obstructive Pulmonary Disease (COPD) in a Rural Community in Northern Thailand
The purpose of this study was to describe the experience of community-dwelling older adults living with chronic obstructive pulmonary disease (COPD) in a rural community in Northern Thailand. The study was grounded in Parker and Barry’s model of community nursing practice model based on the concepts and values of respect, persons in their wholeness, and caring in nursing. Data were generated and analyzed using Giorgi’s phenomenological approach. Four themes were revealed: confronting a life-threatening illness, caring for self, keeping meaningful relationships, and living guided by spiritual beliefs. The meaning of the experience was synthesized as finding balance between living with a threatening illness and living meaningful lives.