Psychosocial Aspect Of Older Adults Flashcards
Mental health risks in nursing homes
Abuse, neglect, involuntary seclusion, somatic disease, psychiatric comorbidities, cognitive decline, poly pharmacy, extrapyramidal symptoms, adverse side effects of psychotropics
Extrapyramidal symptoms
Movement dysfunction such as dystonia, tardive dyskinesia, bradykinesia, tremors, rigidity, akathisia (feeling restless, need to move), parkinsonism
Consequences of inattention to mental health
Physical: somatic and health challenges, cog decline, polypharm and adverse side effects of medication, accelerated molecular brain aging, decreased physical function
Social/emotional: psychiatric comorbidity, barriers to accessing health care, stigma and discrimination, financial difficulties/decreased income
Depression statistics
17% of US population, 50% of older adults, more women
Reactive depression
Neurotic or exogenous depression, linked to significant life event
-loss of spouse
-loss of (I)
-new dx
Psychotic depression
Endogenous or unipolar depression, associated with previous experiences at a younger age, frequent h/o psychiatric illness, signs of institutionalism, frequently misdx as dementia
Paraphrenia
Delusions of persecutions with auditory hallucinations, preoccupied, suspicious, aggressive behaviors
Geriatric depression
Men experience different sx (memory complaints), older men have the highest suicide rates
Geriatric depression leads to:
Increased ED/dr visits
Use more medication
More outpatient charges
Increase LOS in hospitals
Life satisfaction
Self-evaluation of one’s life as a whole, influenced by socioeconomic, health, environmental
Decreased life satisfaction = increase risk of risky behaviors (smoking, drinking, inactivity), increased risk of obesit
Frequent mental distress effects
Interferes with eating well
Maintain home
Ability to work
Sustaining relationships
Inactivity which leads to poor health
Risk factors for late onset depression
Widowhood
Physical illness
Low educational attainment (less than hs)
Impaired functional status
Heavy alcohol consumption
Anxiety
Uncontrolled feelings of panic, fear, and apprehension, obsessive thoughts, reactions that are disproportional, restlessness, trouble with memory and focus, insomnia, nightmares, refusal to engage in activities, ritualistic behaviors
Underdx in older adults
Generalized Anxiety Disorder
Most common, constant worrying about many things, fearing worst in every situation, feeling a lack of control over emotions
More prevalent in those who experienced divorce, separation, loss of spouse
Social anxiety disorder
Extreme nervousness and self consciousness in everyday scenarios involving others
Marked by:
Fear of judgement
Avoidance of social situations
Difficulty making friends
Phobia
Avoidance of specific situations or objects due to an extreme fear of something that poses a perceived threat
OCD
Experiencing unwanted recurring thoughts and obsessions
Schizophrenia
Increase risk of dementia, prevalence expected to double
Symptoms different in older adults: fewer active positive symptoms (hallucinations/delusions), more passive symptoms (lack of initiative/interest, severe cognition, decreased memory/recall and naming abilities)
Alzheimer vs Schizophrenia
Alzheimer delusions are persecutory, theft, incidental VS schizophrenia delusions are persecutory and though control
Alzheimer hallucinations are more visual VS schizophrenia hallucinations auditory more commin
Alzheimer’s presents with flattened affect, avolition, apathy, poverty of speech/thought VS schizophrenia presents with disengagement and apathy
Alzheimer family h/o =alzheimer’s d/s VS schizophrenia family h/o = major
Mental illness
Alzheimer’s trajectory is progressive declining with aging VS schizophrenia trajectory fluctuates
BIPOLAR D/O
Often mistake with anxiety/depression
late onset bipolar d/o (LOBD) = older adults experiencing manic episode
Early onset Bipolar d/o (EOBD) = older adults with ling standing clinical h/o bipolar d/o
No difference in mortality between the 2
Clinical features of late onset Bipolar D/o
Increased premorbid psychosocial fxn
More affective episodes
Less severe psychopathy
Cognitive impairment
Mood reactivity
Increased appetite/weight gain
Extrapyramidal symptoms
Increased episode duration or chronicity increases with age at onset, hypersomnia
leaden paralysis
decreased mental flexibility
Increased rates of alcohol d/o, GAD and panic disorder
Sensitivity to interpersonal rejection
Increased risk of suidied
CVA 2x more likely
Increased prevalence of mixed eoisodes
Decreased psychomotor speed, selective attention, visual memory, verbal fluency, executive functioning, psychosocial fxb
Dx associated with LOBD (late onset bipolar d/o)
TBI, epilepsy, brain tumor, encephalitis, cerebral infarctions
Common factors leading to suicide in older adults
Older adults plan suicide more carefully with more lethal methods
Loss of self-sufficiency and (I)
Cognitive impairment
Chronic illness/pain
Decreased QOL
Financial troubles 2/2 financial stressors
Grief & bereavement over the loss of loved ones
Warnings of suicide
1)Loss of interest that were previously enjoyable
2) giving away prized possessions/changes will
3) lack of concern for personal safety
4) preoccupation with death or discussion of death
5) neglecting self-care, medical regimens, personal grooming
6) avoiding social activities and isolating themselves from others
Strategies to decrease risk of suicide in older adults
Restrict access to lethal means (firearms, prescriptive meds)
Increase protective factors: social networks, positive coping skills, access to mental healthcare, meaningful engagement in activities
Post suicide strategies
Aim to reduce the risk of further suicides
Provide resources for grief
PTSD
Re-experiencing of traumatic events, avoidance of triggers, reckless behavior, negative thoughts/mood
Causes of PTSD
Sexual/physical assault
Pre-existing psychiatric/personality disorder
Minority status
Decreased education level
Socioeconomic factors
Family hx
Gender (women more likely)
Factors impacting PTSD in older adults
Life altering situation
Role loss
Function loss
Retirement
Increased health problems
Decreased sensory abilities
Decreased income
Loss of loved ones
Cognitive impairment
Decreased social suppory
PTSD OT intervention
Self-reflection through expressive thoughts (dance, drawing, role playing)
Creative coping strategies
Participation in meaningful occupations (increase role competence, promote wellness, and increased QOL)
General PTSD tx
Trauma-focuser talk therapy
Prolonged exposure
Cognitive processing therapy
Eye movement desensitization reprocessing
Medication: SSRIs, SNRIs ie sertraline and paroxetine, SNRI Venlafaxine
Personality disorders
Enduring patterns of inner experience and behavior that deviates from expectations of individual’s culture, pervasive, and inflexible
Onset adolescence or early adulthood, stable over time leading to distress and impairment
Personality disorders in older adult
More common in men
Common types in women are paranoid, avoidant, and dependent
Easily overwhelmed by age related loss/stressors
Long standing pattern of maladaptive interpersonal behavior
Increased risk associated with personality d/o in older adults
Stroke
Heart D/S
Mortality rate
Obesity
Being underweight
Smoking
Alcohol use D/O
DM
Arthritis
GI D/O
OT role in tx personality D/O
Developing adaptive skills to manage symptoms and engage in daily activities
Emotional regulation, problem-solving, communication skills
Facilitate social activities and develop meaningful relationships ie group therapy
Sensory modulation therapy, sensory integration techniques, increased attention, deep pressure, brushing
ADLs
Environmental mods
Cluster A Personality Disorders
Odd or eccentric
Paranoid personality
Schizoid personality
Schizotypal
Paranoid personality
Pattern of distrust and suspiciousness that other’s motives are malevolent
Schizoid personality
Pattern of detachment from social relationships and restricted range of emotion, appears cold and indifferent
Schizotypal personality
Pattern of acute discomfort in close relationships, cognitive/perceptual distortions, and eccentricities of behavior, odd perceptual experience and social anxiety
Cluster B personality Disorders
Typically dramatic, emotional, or erratic and evokes reactions in others
Antisocial personality
BPD
Histrionic personality
Narcissistic personality
Antisocial personality disorder
Pattern of disregard and violation of rights of others
Borderline Personality Disorder (BPD)
Pattern of instability in interpersonal relationships, self-image, and affects. Marked impulsivity, intense with relationships, fear of abandonment, self harm and suicide
Histrionic personality disorder
Pattern of excessive emotionality and attention seeking, constant need for attention, seeking emotional soothing, can’t self sooth, may be overly sexual, dramatic, provocative behavior, rapidly changing emotions, thinks relationships are grander/closer than they are
Narcissistic Personality D/O
Pattern of grandiosity, need for admiration, lacks empathy, believe they are more important
In LTC may look like the pt who thinks they should come first, fantasy about power, success, attractiveness, exaggeration of achievements, expectation of praise
Cluster C personality D/O
Traits of anxiety and fearfulness, goes under notice bc not as emotionally provoking as cluster B
Avoidant
Dependent
OCD
Avoidant personality D/O
Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation, take criticism hard, stay to themselves, avoids activities
Dependent Personality D/O
Submissive and clinging behavior related to an excessive need to be taken care of, need to be cared for vs histrionic which is need to be soothed, asks for more help than they need, fear of having to do self care, difficulty starting on own without others, fear of disagreeing, tolerance of poor treatment
OCD
Pattern of preoccupation with orderliness, perfectionism, control, rigid, inflexible, keep broken objects, need to fix
What do different personality d/o have in common?
Difficulty with relationships
Restlessness
Anxiety/risk of depression
Difficulty in social situations
Trouble making decisions
Difficulty trusting others
Afraid of rejection
Difficulty maintaining relationships due to poor coping mechanisms
Common interactions of people with personality disorder
Acting out, denial, splitting, devaluation, idealization, help-rejecting, complaining
Personality Disorder Interventions
Psychotherapy, medication, behavior management
Supportive strategies include clear communication, team support, consistent approach amongst all team members, boundary/limit setting
SBAR situation background assessment recommendation
Ongoing health plan not just crisis based
Take turns treating to limit staff burnout
Guidelines to support Personality Disorder
Id problem-> gather info -> what happened before the problem-> set the realistic goals -> reward self and others for achieving goals-> continually assess/modify plan -> alter your (provider) behavior->change environment -> revisit expectations
Psychotropics prescribed to older adults
Antipsychotics, antidepressants, anxiolytics, antilepileptics, anti Parkinsonian drugs, dementia mgmt
Negative aspects to psychotropics
Leads to decreased QOL in 80%
Adverse effects including mental status
Cardiovascular exacerbation
Tardive dyskinesia
Hypotension
Above leads to increase risk of falls and fxs
Positive aspects of psychotropics
Symptom management: stabilize mood, decreased agitation, increased sleep, alleviate distressing thoughts
increase social/occupational function: manage symptoms to increase engagement in meaningful occupations =increased well being
Facilitates engagement in therapeutic interventions
Crisis intervention: provides immediate relief and stabilizes mental health
Social determinants of health (SDOH)
Conditions in the environments where individuals are born, live, learn, work, play, worship
Addressing SDOH decrease health disparities
SDOH accounts for 60% of population health out omes
5 domains of Social determinants of health
education access/quality: increase education more likely to be healthier
Economic stability: more stability leads better health, low incomes leads to less healthy foods, injury leads to less job opportunities
Social and community context: increase social support combats risk factors
Neighborhood and built environment: major impact on health ie high rates of violence, unsafe air, unsafe water, racial/ethnic groups with low incomes increases health risks
Healthcare access
Healthy People 2030
Providing high equality education
Helping people get social support
Improving access to to quality and timely healthcare
Elder abuse
1 in 10 (neglect and exploitation)
Men have higher rates of both nonfatal assaults and homicides (75% and 35% in women)
Steps to reporting abuse
Id whether abuse is occurring through observation and speak to older adult about possible presence of abuse
Assess risk: is situation emergency vs non emergency and take action
Document
Report to state and organizational policies for reporting
Loneliness and social isolation
35% of adults older than 45 experience social isolation
Leads to depressive symptoms, decline in cognition, drinking alcohol, fall risk, lack nutrition, hospital readmission, infectious disease, and increased mortality rate, stroke, htn, cardiovascular d/s, obesity, suicide ideation, progression of dementia, premature death
Identifying loneliness
Revised UCLA loneliness scale
De Jong Gierveld Loneliness Scale
Single item scale
Interventions for loneliness
Improve social skills (nonverbal/verbal communication, CBT)
Increase social support (friendly visitor, virtual connections, meal delivery, in home support)
Increase access to social interactions: telephone outreach, online chat, hearing aids , transportation services, social activities
Change unhelpful thoughts about social situations CBT
OT intervention: access available resources, facilitate social networks, address architectural barriers
Loss 6 types
Encompasses various aspects of life and significantly impacts mental health
Material: lost possession (item/income)
Relationship: change in social status
Intrapsychic: loss of self image due to bereavement, completion of task or failure
Functional loss: loss of autonomy, occupational deprivation
Role loss: retirement, acquiring new roles, responsibilities (becoming a patient)
Systemic loss: loss of function within an existing system, retiring or illness impact on function in family
PTSD impact on occupation
Struggle to perform self car, experience sleep problems, face community mobility challenges, difficulty with meal plan and financial planning
Limitations in driving lead to ability to engage in work or productive activities
Leisure: decreased interest/motivation
Differences between older/younger PTSD
Less prevalent in older than younger veterans
Older vet c2o somatic symptoms (appetite, sleep, memory)
Iate onset stress symtomatology
Development of increased thoughts and reminiscence about emotional response
UCLA Loneliness Scale
3 questions, developed for providers, short/academically rigorous, simple score, negative wording
Campaign to End Loneliness
3 questions, positive wording, for service providers, short sensitively worded tool
De Jong Gierveld Loneliness scale
6 questions mixed positive and negative wording
For researchers
Distinguishes between different causes of loneliness
Single item scale
Scale for loneliness
1 question
Negative wording
Used for researcher
Kubler-Ross Grief Cycle
Denial: disbelief, numbness, struggling to accept reality of loss
Anger
Depression
Bargaining: pleading, asking for loss to be reversed, blaming loss on something you cannot control
Acceptance: accommodating and adjusting to new reality, living with the loss
OT settings in Mental Health
Acute, LTC, forensic/juvenile justice centers, hospitals, residential/day programs,SNF, schools, community-based mental health centers, employment programs, military, private practice, outpatient, opioid treatment programs, preventative health, certified community behavioral center
Barriers to OT mental health services for geriatrics
Limited resources
Inadequate alternatives
Decreased # of OTs
Need for improved knowledge base in OT
Need for QA methods
Underutilization of mental health services by elderly
Things to consider when choosing activity to improve engagement in older adults with SMI
Engagement: Reduces wandering
Reduces need for restraints
Fear of failure leads to avoiding activity so grade for success for sense of productivity, focus on continuing roles (homemaking/religious role in facility)
Base on client’s motivation
Task simplification for participation and success
Risk of agitation, activity will inform what precipitates agitation and aggressive behavior/catastrophic reactions then educate staff on triggers
Dementia group: increasing engagement
Goal is to maximize use of time
Use clear directions, concrete cues, and specific first step instruction
Compensate for mistakes rather than draw attention/minimize consequences of mistake due to fear of failure leading to activity avoidance
Benefits of groups for dementia
Engagement in activity
Enhance integrity
Monitor functional level secondary to psychotropic medication titration
Preserve autonomy
Increase safety
Reduce wandering behavior
Reduce use of restraints
Individual placement and support model
Supported employment
OT intervention for SMI
Teach and support coping strategies and symptom management
ID and develop habits, rituals, and routines
ID personal values and goals
Support creation of wellness recovery action plan
Provide info on community based resources
Info on monitoring health concerns
Increase ability for long term planning
3 tiers of services for mental health: tear 3
Intensive, used with identified mental, behavioral and emotional disorders
Settings: inpatient behavioral health, community mental health, alternative/public schools, home based, residential/organizational work places
Tier 3 types of interventions/services
CBT, motivational interviewing, stress reduction, trauma-informed care, DBT, supported employment/education, sensory strategies, normative life roles, community integration, social skills promotion groups, ID health habits/roles/rituals/routines, functional assessments, occupational engagement to reclaim mental health and QOL, Recovery model
Recovery Model
Focuses on enabling persons with Mental health challenges through client centered process to live a meaningful life, empowering individual to maintain control over theirs lives than just striving for pre-illness state
Holistic approacg
Self management strategies to increase efficacy than models just focused on physical health
Emphasizes self-discovery, personal growth, goal setting
3 tiers of services for mental health: tier 2
Targeted services, at risk individuals to prevent mental health problems, individual may not have formal ID’ed mental health Disorder
Settings: hospitals, clinics, schools, residential/home, and community based environments
Tier 2 services
Occupational engagement focused
Decrease early symptoms
Small therapeutic groups, environmental modifications to increase participation, modification of expectations vs expected task, coping skills, social/emotional competencies, strategies transitioning and re-entry into community
3 tiers of mental health services: tier 1
All individuals with or without mental health/behavioral problems
Universal programs that promote mental health
Educational and teaching strategies
Development of coping strategies such as yoga, self-regulation, and mindfulness
Mental health literacy
Early signs of mental illness in older adults
Trouble remembering things, frequent mood changes, social withdrawal, changes in personal care, changes in appetites, physical complaints, lack of interest, expressing negative thoughts, unusual behaviors
6 steps to integrating theory to intervention: therapeutic reasoning
1) generate clinical ? Based on concept of the a model
2) collect info from person
3) creating a picture of thats person’s experience
4) working with person to generate intervention plan, goals, and strategies
5)implementing plan
6) evaluate outcomes
Purpose of assessments
Establish a baseline
Document changes
Provide clinical observation
Mark progress
Assist in client centered planning
Generate evidences
Serve as outcome measures
MMSE: mini mental status exam
Cognitive function including orientation, attention, memory, visual spatial skills, language
Short portable mental status questionnaire
10 item questionnaire used to assessed cognitive function, designed for quick administration
0-2 intact
3-4 errors mild
5-7 errors moderate
8-10 errors severe
Executive function performance test
Person’s ability to perform real world tasks that require cognitive skills including cooking, telephone use, and med mgmt
Top down approach that shows amount of assist needed for task completion, individuals capacity for independent function, executive function impace
Executive function performance test tasks
Performed in order
Handwashing (if unable to follow do not proceed)
Oatmeal prep
Telephone use
taking medication
Paying bills
Allens Cognitive screen
3 craft based tasks, leather lacing stitches to assess learning and problem solving
Routine task Inventory RTI
Part of Allen’s Model of Cognitive Disability, semi-standardized, 25 ADLs and IADLs
4 subscales—> physical adls, community IADLs, communication, and work readiness
Direct observation in naturalistic context/perception of performance by client/caregiver, associated with 6 levels of ACO
allen diagnostic module
Battery of 34 standardized assessments of cognitive abilities needed for ADLS, leisure, or work tasks, craft based for new learning and problem solving
Verify results of ACLs
Allen’s Cognitive level 0
Reflexes/coma
Allen’s Cognitive Level 1: automatic
Withdraws from noxious stimuli, responding to one sensory stimulus, locating stimuli, rolling in bed, raising a body part
Allen’s Cognitive level 2: postural actions
Sitting, righting reactions, standing, aimless walking, directed walking, using grab bars
Allen’s Cognitive level 3: manual actions
Grasp, distinguishing objects, sustaining actions on an object, noting effects on objects, using all objects
Allen’s cognitive level 4: goal directed
Sequencing familiar actions, differentiating features of objects, completing a goal, personalizing features of objects, learning by rote memorization
Allen’s Cognitive level 5: exploratory
Comparing and changing variations in actions/objects, discriminating among sets of actions/objects, self-directed learning, social standards, consulting others
Allen’s Cognitive level 6: planned
Typical functioning adults
Cognitive Performance Test
Initially developed to assess Alzheimer’s disease and dementia
Intact 5 or 6 to profound disability level 2
Montreal Cognitive Assessment MOCA
30 point questionnaire to assess cognitive decline in memory, attention, and language
Beck’s Depression Scale
21 questions self report inventory
Clinical research, used with those diagnosed, self report of depressive symptoms
Elder depression scale
Self-report measure to identify depression in older adults
Hamilton Depression Rating Scale HDRS
Multiple item questionnaire, indication of depression and guides recovery
Weekly Calendar Planning Activities WCPA
Assesses executive functioning, ability to plan or organize activity for a week
10-18 appointments/errands
Need to adhere to rules, monitor time, and manage conflicts
Assesses mild executive function deficits for those I with IADLs, not rated but direct observation in performance wrrors
Weekly Calendar Planning Activity applicable population
Ages 12-94: TBI, MS, Brain tumor, parkinson’s disease, stroke, MCI, Cancer, renal/cardiac disorders, COPD, Lupus, RA, DM, autism, ADHD, CP, schizophrenia, BD, depression, substance abuse, PTSD, community dwelling adults
3 levels of Weekly Calendar Planning activity based on age and cognitive ability
Level 1- organize checklist with cues, preplanning not required
Level 2- unorganized list of appointments, no curs, pre planning required
Level 3- paragraph of appointments with irrelevant info included, need to sort out relevant infor
WCPA short form
Level 2 weekly Calendar Planning Activity, frequently used in inpatient setting due to tome constraints, 10-15 minutes
Semi-structured interview s/p task to see insight
Self-rating of awareness, performance, and strategies
Hamilton Anxiety Scale
Quantify severity of anxiety symptoms, psychotropic drug evaluation
Schroeder-Block Campbell Adult Psychiatric sensory integration evaluatio
Sensory processing assessment, physical/motor functioning including abnormal movement disorders process vs medications
Coordination, grip, diadochokinesis, gait, neck ROM, posture
Draw 2 circles
Adolescent and adult sensory profile
Family of self-report tools that evaluate behavioral responses to everyday sensory experiences, quantifying 60 items
Age 11+
Taste/smell, movement, visual, touch, activity level, and auditory
15 items each quadrant: low registration, sensory seeking, sensory sensitivity, sensory avoiding
Represents patterns of sensory processing, Dunn’s Model of Sensory Processing
Dunn’s Model of sensory processing
Neural regulation occurs as a balance of excitation and inhibition which creates thresholds for responses
Goal Attainment Scale
Assesses performance/roles, formulating/tracking individualized goals
Scales goal; much less than goal, less than goal, expected outcome, more than goal, much more than goal
Activities Health Assessment
Performance/roles, assesses ability and confidence to perform various ADLs
Time usage
Patterns
Roles
Skills
Habits
Configuration of activities
Color coded chart of how time is spent during the week, questionnaire and interview
Canadian Occupational Performance Measure
Detects client’s self-perceived change in occupational performance overturn setting intervention goals
Occupational Case Analysis Interview and Rating Scale (OCAIRS)
Structured to gather, analyze, and report data on individual’s occupational participation, describes hx and performance
Occupational Performance History Interview (OPHI)
MOHO, semi-structured interview to explore client’s life hx in areas of work, play, and self-care
Role Checklist
MOHO based, asseses client’s perception of roles and value in role in their role, self report survey, not normed based
10 roles:
Student
Worker
Volunteer
Caregiver
Home maintainer
Friend
Family member
Religious participant
Hobbyist
Participants in organizations
Select roles and rate satisfaction on 4 point likert scale
Occupational elder abuse checklist
Tool used to identify elder abuse
Occupational experience profile
Semi-structured interview to help clients identify their occupational
History, patterns, values, interests, personal causation (MOHO)
Activity Card Sort
Assesses individuals participation in 20 Instrumental activities, 35 low physical demand leisure, abd 17 high physical demand leisure, and 17 social activities
Level of engagement and if activity has been discontinued, 60+ years
Social community integration scale
Degree which individuals with chronic conditions are integrated into their community
Performance Assessment of selfcare skills PASS
Assesses functional tasks needed to live independently in the community, 26 core tasks in 4 domains
Criterion referenced, performanced base
4 domains of the performance Assessment scale
Functional mobility, BADL, IADLs with physical emphasis, and IADL with cognitive emphasis
Emotional Regulation Questionnaire
Psychological assessment, assesses individual’s tendencies to regulate emotion in cognitive reappraisal and expressive suppresion
Satisfaction with Life Scale
Measure of life satisfaction, subjective well-being, psychological assessment
Independent living scale
Assesses client’s ability to perform tasks related to independent living, weighted score , 65+ age, dementia, MR, TBI, psychiatric disorders
5 scales of Independent Living scales
1) memory orientation
2) managing money
3) managing home/transportation
4) health and safety
5) social adjustment
Mental Health Continuum Short form
Self-report measure that assesses emotional, psych, and social well being
Test of grocery shopping skills
Performance base measure on client’s ability to shop
For groceries efficiently and accurately
Population: mental illness, developmental disability, tbi
Nonstandardized therapeutic writing
Informal psych assessment, encouraged expression to increase understanding of feelings, experiences, and thoughts to facilitate healing and personal growth
Leisure education programs
Increase social participation, decrease stress, improve psychological well being, and provide meaning in daily, decreases decline in cognition, And physical dysfunction
Exercise, weight loss, and relaxation as interventions for mental health
Tai Chi improves depressive sx
Exercise shows positive results for schizophrenia, anxiety, and dementia
Yoga positive for schizophrenia and anxiety, mixed research for depression
Relaxation increases psychosocial well being
Behavioral interventions for mental health
More effective in improving depression and sleep quality
CBT groups
Focus on thought challenging, problem-solving, behavioral social skills training (seeking social supports)
Functional Adaptation skills training (FAST)
Social skills training in Communication, transportation, medication management, social skills, organization, planning, and financial management
Helping Older People Experience Success (HOPES)
Psychosocial skills and preventative healthcare management
Adl and IADL groups
Independent living skills including nutrition, cooking, gardening, money management, transportation, social/leisure
Cooking increase psychosocial well being, socialization, self-esteem, QOL
Community reintegration groups
Woodwork
Leisure group
Arts, crafts, woodworking
Reminiscence group
Group collage, life story book, life review through writing/oral story telling
Decreases depressive symptoms and risks of Alzheimer’s disease
Sensory awareness and stimulation group
Feeling oriented discussion, role playing, poetry, music snoezelen
Snoezelen
Controlled multisensory environment
Placing individual in soothing stimulating environments
Reduces agitation and anxiety
Promotes engagement and communication
Coping skills group
Reality oriented discussion groups, transactional analysis, assertiveness training, role playing
Validation therapy
Validity and dignity to feelings expressed by disoriented clients who no longer benefit from reality orientation, resolves past conflicts, uses empathy
Sensory integration group
Weighted blankets decrease anxiety and stress
Anxiety management group
Relaxation techniques
Self-expression group
Art, collages, role playing, self awareness exercises
Intergenerational programs
Engage different generations in planned activity to increase meaning and purpose
Foundations of therapeutic use of self
Establish rapport
Respect client’s wishes
Maintain personal honesty
Strong communication skls
Person centered strong listening skills
Instill sense of security
Nonjudgmental feedback
Acknowledge mistakes
Inter-profession intervention models
Prevention/early intervention: short term mental health tx, mild to moderate issues, prevent exacerbation and increase QOL
Collaborative Care Model: team based evidence based dx, tx, and follow up with mental health concerns “primary setting
Collaborative Care Model
Used with Substance abuse, improves access, clinical outcomes, pt satisfaction, cost-effective
Components:
Team (PCP, care manager, psych consult, therapy)
Population Based Care: proactively manages pt’s with condition in a practice
Measurement based tx: tx determined by quantitative assessment of clinical status, standardized tools
EBP
Accountable care: practitioners accountable for quality of care and pt’s outcome
Trauma informed care mod
Assists practitioners in understanding interconnected factors contributing to an individual’s trauma
Examples racism, prejudice, bias
Prolonged exposure to trauma leads to chronic health conditions, DM, chronic pain, heart disease, cognitive decline
Goal: create safe space/avoid retraumatizatiin
6 Key principles of trauma informed care
1) safety: client to feel secure and comfortable in therapeutic relationships and settings
2) trust worthiness and transparency: rapport, building trust is critical, communicate clearly to improve comprehension of tx process
3) peer support
4) collaboration/mutuality: shift from traditional power dynamic, shared decision making, partnership
5) empowerment voice/choice: check in, ask for permission, seek client’s opinion
6)cultural, historical, and gender issues: be aware of discrimination, marginalization can impact suicidality
3 phases of traumatic stress program
Phase 1: safety planning, coping skills, wellness recovery plan
Phase 2: addresses losses, boundaries, self-esteem, guilt, and forgiveness
Phase 3: engagement in meaningful occupations and post traumatic growth and resilience
Acceptance and commitment therapy in trauma informed care
Psychological flexibility, being present and open to experience, taking action guided by values
Decreases PTSD sx
BioPsychosocial Model
Biological, psychological, and sociological
Fight: combative, struggling for personal power, may appear non-compliant
Flight: tx resistant, may appear uncooperative, disengaging
Trauma response: adaptation may come out in therapy
Lawton’s Environmental press theory
Behavior is communication
Adaptive functioning depends on interaction between stimuli and pt’s capacity
Trauma brain
Dysregulated behavior due to more emotional brain than thinking brain less engaged
Ways to help someone regulate their brain after trauma
Warmth, validation, flexibility, structure, hope, humor, being part of connected community
Trauma informed vs trauma specific tx
Takes into account knowledge about trauma in all care vs evidence based, best practice tx model that facilitates recovery from trauma
Not specifically designed to treat sx related to trauma vs directly addresses impact of trauma on an individual’s life and facilitate recovery, treat consequence of trauma
Trauma informed care: philosophy of care that recognizes possibility of trauma in client’s hx
Recovery Model
Centered around concept of resilience, empowering individuals to maintain control over their lives more than merely striving to return to pre-illness state
Holistic approach to mental illness
Self mgmt strategies have higher efficacy of those focused on physical health
Emphasis self-discovery, personal growth, goal setting
Recovery Model Oriented Approach: WRAP-Wellness Recovery Action Planning
Individualized prevention and wellness tool
Manage mental health with personalized strategies
Recovery Model Oriented Approach: DREEM-Developing Recovery Enhancing Environments Measure
Assesses how well a service’s environment supports recovert
Recovery Model Oriented Approaches: Recovery Star
Tracks and supports recovery by measuring progress across various life areas affected by mental gealth
Recovery Model Oriented Approached: Checklist of Good Practice
Set of guidelines for health services personnel to ensure practice supports to recovery
Healthy IDEAS- Identify Depression Empowering Activities for Seniors
service delivery model
Self management program to identify, manage, and reduce depressive symptoms
Empowers by advocating for mental health wellness, links to providers
PEARLs- Program to Encourage Active Rewarding Lives for Seniors
Alleviate depressive sx and enhance QOL for senior community/older adults
Promotes active engagement and rewarding experiences
Educates on what depression is
Empowers with new skills
Train coaches within community based organizations
Problem solving, activity planning, and connections reduces social isolation, loneliness, lowers hospitalizations, and nursing home stays
BRITE- Brief Intervention and Treatment for Elders
Screening and intervention solutions geared towards with substance abuse issues
Motivational interviewing
Uses health promotion work book
Summary of goals to improve QOL
Health Habits
Education
Occupational Justice
Recognizing/fulfilling occupational need, all people engage in meaningful activity
Risks during Transitional Care
Older adults are vulnerable secondary to misdiagnosis, underdiagnosis, and over diagnosis due to sx being attributed incorrectly to aging
Instinctual Trauma Response Model
Educate individual on how brain and body are wired and why they react to traumatic situations, trains responses
Benefits of social networks/aupport
Acts as buffer against stressors
encourages help seeking behavior
Validating and developing self concept
Increase self esteem, mood, and worldview
Provides structure to learn/adapt new skills
Community Based Services: Care Program Approach
Prevents vulnerable clients from falling out of care, integrates social care management, prioritizes severe mental illness
Community Based Services: Early Intervention in psychosis services
Initiative focuses on addressing psychosis at early stages
Community Based services: primary care liaison teams
Provides resources to PCP referring clients yo specialty services
Medical marijuana
Treats symptoms of chronic pain, sleep, malnutrition, depression, side effects of Ca tx
Not FDA approved as medicine
Medical marijuana risks
Respiratory conditions, decreased memory, adverse cardiovascular function, alters judgement and motor skills, psychosis
Role of OTP in medical marijuana use
Educate pt and/or caregivers on use, risk vs. benefits on individual basis
Monitor adverse effects
Educate on how affects compromise safety
Non-pharmacological pain intervention
Non-pharmalogical pain intervention
Relaxation techniques and physical exercise and how to integrate into habits/routines for sustainable carryover
Ergonomics, nerve mobilization, functional mobility, home evals, positioning, equipment, ECT, pacing, cognitive strategies
Symptom tracking, med mgmt, modalities, sensory strategies, self regulation techniques, eating strategies to avoid dietary pain triggers
Sleep hygiene, fatigue mgmt with CBT
Assertiveness training, compensatory strategies, body mechanics, community reintegration
Risks of unhoused older adults
30% of income on rent increases risk of homelessness
Experiences extreme occupational deprivation
Lack of access to resources for BADLs
Routines dictated by context ie transportation, wait lines at meal program, showers during shelter hours
Priority is maintaining safety and personal items
OTP intervention and homelessness
Practice skills that fit routine/navigate community
Provide Resources
Adapt environment
Strength based Language
Develop/refer to providers
Assess boredom and engagement in meaningful activities survey and multidimensional state of boredom scale
Tx in small group/individual using checklist, role playing, searching resources, setting reminders, creating daily schedule, grooming routines, Identifying coping strategies, med mgmt, exploring leisure interests
Apply strategies together then add more complex performance skills for community transition
Cognitive Orientation to Occupational Performance Theory (coop)
Performance/occupation based approach for children and adults who experience difficulties performing skills they want or need to perform
Cognitive strategies to improve task performances
Goal plan check do, skill acquisition, cognitive strategy use, generalization, and transfer of learning
Leads to increased self efficacy
Occupational Adaptation
OT frame of reference, integrate occupation and adaptation domains
Occupation=self-perceived meaningful activities
Adaptation=one’s response to meet occupational challenge
When response is insufficient to master activity, focus on environment and roles to promote relative mastery
Theory of occupational adaptation: process of internal adaptation= self efficacy
Hoarding Disorder
Persistent condition characterized by compulsive hoarding and sx that result in decreased health, daily function, psychiatric comorbidites and cognitive functioning
Associated Risks with Hoarding
Fall risks
Fire hazards
Poor hygiene/nutrition
Escalation in medical issues
Food contamination
Social isolation
Medication management
Exacerbation pre-existing chronic health conditions
Hoarding associated health conditions
61% HTN
11% stroke
22% sleep apnea
11% seizure disorder
80% limited mobility
10% cannot use toilet, 70% difficulty using stove, decreased rest and leisur
Mood disorders associated with Hoarding
51.4% MDD
23% GAD
23% phobia
18% OCD
13.8% specific phobia
7.1% PTSD
OT interventions for Hoarding
CBT: stop hoarding by changing thoughts and behavior, poor evidence
Help hoarders engage in activities that bring intrinsic value and promote well-being
Support roles in the community
Hoarding and decluttering
Decluttering or throwing out possessions leads to emotional distress based on loss of environment, not loss of connection to item or home
Leads to overstimulation, hostility, and does not address underlying problem
Occupational imbalance
Hoarding leads to occupational imbalance due to lack of ability to participate in other roles
Tx by promoting engagement in activities to redevelop lossed skills
Pacing, grading, and adapting task to promote success for self achievement
