If you have been following our blog series covering the 2011 Annual Report, then you know that our team has captured moving stories from older adults themselves who have benefited from the programs and services funded by the Hartford Foundation. I would like to highlight one such video about Patty, who has dementia but whose family observed a complete personality change in her after she fell and fractured her hip.
Delirium, for the inexperienced health care provider, is hard to differentiate from dementia. Patty was fortunate to have had Dr. Lalith-Kumar Solai, a psychiatrist from the University of Pittsburgh Center of Excellence in Geriatric Psychiatry, as her doctor. He adjusted Patty’s medications and was able to determine that Patty also had an untreated urinary tract infection. With antibiotics, the infection cleared and so did Patty’s delirium. The family was relieved to see their mother return to her usual calm and loving personality.
When I was in graduate school (a very long time ago!), I recall taking a number of courses in the mental health specialization in the MSW program. There was almost no aging-related content in any of the courses except for a lecture on “Organic Brain Syndrome.” The limits of the mental health curriculum became painfully apparent when I got my first job at a community mental health center. I saw several older clients, some with a diagnosis of chronic schizophrenia, some with serious chronic diseases like COPD, some of whom were depressed, some who drank alcohol, and some who had started to have difficulties with performing their activities of daily living. I embarked on a very steep and long learning curve as I slowly began to learn more about aging, mental health, and the service systems that operated in their own silos. The “aging services” system was separate from the mental health system and neither was well equipped to address the mental health needs of older persons. Fast forward to the present and we find that the majority of social work schools still have very limited course content on understanding and addressing the interplay of health and mental issues among older people and unsurprisingly, the service systems have not changed very much either.
Thankfully, both the John A. Hartford Foundation and the Institute of Medicine (IOM) recently released reports highlighting the critical need for practitioners in geriatric mental health services. Both reports describe the need for increasing the number of care providers who are properly trained in diagnosing and treating mental health issues among older clients. While educators and service providers may operate in their own silos (health care, mental health care, aging services), our older clients or patients do not. They bring with them a tangled web of issues that impact myriad aspects of their daily lives.
I feel fortunate to have had the chance to make a difference in improving geriatric mental health training as the PI of the Gero-Ed Center’s Master’s Advanced Curriculum (MAC) Project. The MAC Project brought together a diverse group of social work faculty with expertise in mental health, health, and substance use who developed outstanding educational materials that are being used to train current and future social workers on geriatric mental health issues. One teaching resource that would have been helpful for my own clinical work many years ago is a series of videos, case studies, and evidence-supported lecture notes addressing differential mental health assessments (depression, cognition, substance use) for a diverse group of seniors presenting with chronic illnesses (COPD, diabetes, ischemic strokes).
Recently, you heard from the creative team—our writer, photographers, and videographers—for our award-winning 2011 annual report focused on mental health and older adults. In that blog post, Don Battershall reported that in order to capture the stories of the older adults, caregivers, and health care professionals featured in the annual report, he needed to “really slow down and just listen, let the person talk.”
Today, we are delighted to give you the opportunity to “slow down and listen,” just as Don did, through the first of our collection of 2011 annual report videos.
The first video features Elizabeth, an inspiring older adult who overcame years of depression triggered by the murder of her daughter and subsequent death of her husband. Elizabeth, together with her Depression Care Manager Rita Haverkamp, RN, MNS, CNS, participated in Project IMPACT—a successful, Hartford-funded model to assess and treat depression in a primary care setting.
As our dedicated 2012 Hartford Foundation annual report blog series followers know, our August 7 blog featured the creative team behind our award-winning annual report. Intrigued by their stories, we asked our annual report writer, Lynne Christensen, to tell us more about her experience writing about mental health and older adults.
Writing this year’s annual report had personal significance for me that I could not have anticipated when I began the project. About halfway through the writing process, I learned that my 81-year-old mother needed a heart valve replacement, and the surgery couldn’t wait. It was a traumatic surgery for someone her age.
This year, I get to brag again. Our 2011 Hartford Annual Report focused on mental health and older adults won a Silver Award in this year’s Vision Award competition. (As an official Hartford Bean Counter, I do feel obliged to report that our overall score of 97/100 was higher than last year’s 96/100.). Again, we won accolades for our narrative, creativity, and information accessibility, earning perfect marks on all.
Rather than simply bragging, I want to do some thanking. While Frank Doll, Nora OBrien-Suric, Jessie White, and I worked pretty hard on this report, the real, creative heavy lifting fell to Lynne Christensen (writer), Don Battershall (designer/photographer/videographer) and Will Mebane (photographer/videographer).
It happens all too often: an older adult goes into the hospital and starts behaving strangely—hallucinating, rambling, showing signs of agitation, or becoming disoriented. He or she may not even recognize loved ones. What’s the diagnosis according to far too many health care providers? Dementia. And this despite the fact that dementia always has a gradual, not sudden, onset.
What’s the solution? We need to educate health care providers as well as older adults and their loved ones about delirium and other mental health issues. The solution lies in astute practitioners like Pamela Cacchione, PhD, RN, BC, and her nursing student, Ashley King, MSN, RN, who had the skills and clinical training to assess and address Roberto’s delirium in order to restore his quality of life.
Hot off the press is the web version of our most recent annual report focused on older adults and mental health—a topic near and dear to many of us at the Foundation.
In May 2002, my friend Tucker killed himself. Alone in his apartment, he used a gun to commit suicide. What haunts me (and many of his friends) to this day is that we had no idea that he was depressed. None. For years, Tucker apparently put on a brave face and silently suffered.
Such is the case with many older adults. Of the 40 million Americans over the age of 65, about 7.5 million have a mental health disorder and this number will grow as more of our population ages. Many older adults with mental illness suffer needlessly as they may have not been diagnosed, receive inadequate care, or worse—get no care at all. This despite the fact that adults over the age of 65 have a disproportionally higher rate of suicide than other age groups, with white males 85 and older having the highest.
We have done so for a few reasons: because we are proud of these BAGNC nurses and because quite frankly, the annual report rocks. It does so because of the amazing photos and the clear, compelling text. Both tell our nursing stories in a creative format to educate, inform, and inspire others.
I can shamelessly brag about the report (along with my annual report colleagues, Marcus Escobedo and Frank Doll) because we had the fun role of “managing” and “overseeing” the process. The people that did the heavy lifting were writer Lynne Christensen, photographer/designer Don Battershall, and photographer Will Mebane.
Earlier this month, I spoke—along with many colleagues in the health professions—at a Capitol Hill briefing with Senator Kohl (D-Wis) and his staff. Senator Kohl sponsored Senate Bill 245, Retooling the Health Care Workforce for an Aging America Act of 2009, which amends the Public Health Service Act to require the expansion of training to insure a geriatrics-competent health care workforce. Sponsored by the Eldercare Workforce Alliance, a Hartford grantee, the briefing focused on the importance of increased funding for these training programs. This briefing was an incredible experience for me. As a first generation college graduate, who was born and raised in Arkansas, I would never have expected to be influencing national policy, or to be recently promoted to Associate Professor at the University of Wisconsin-Madison; I thank Hartford for my good fortune. I truly believe that the faculty development programs within the Geriatric Social Work Initiative (GSWI)—the Doctoral Fellows Program and the Faculty Scholars Program—are the foundation of my success as a geriatric social work educator and researcher.
The 10th anniversary of the GSWI—featured in the 2009 Annual Report–is the perfect opportunity for me to thank Hartford for the opportunities the Foundation has given me. (See my profile in the Annual Report for more background.) The Doctoral Fellows and Faculty Scholars programs not only provided me with financial security that allowed me to focus on my aging-related interests, but also introduced me to other Hartford grantees. With geriatrics still an unfortunately small concentration within the field of social work, it is very helpful to have a network of colleagues I can contact for support and for the sharing of ideas and resources.
I am eager to help persuade the next generation of social workers that they, too, can enjoy a fascinating career in clinical or academic social work by focusing on aging. I teach undergraduate students and guest-lecture as much as possible in other undergraduate courses. My main message is that elders are just as complex and rewarding to work with as children and families. Students are often surprised to hear that young people are not the only ones who struggle with drug and alcohol addictions, abuse, depression, suicide, eating disorders and other issues—elders do, too. Right now, however, I am happy if I can convince four or five out of 100 students in a classroom to approach me concerning learning more about geriatric social work. Unfortunately, four or five out of 100 aren’t going to be enough to fill all of the social work positions needed to serve our nation’s growing number of elders. Most of these jobs will be filled by more traditionally trained, children-and-family-focused graduates. That’s why Hartford’s curriculum-related programs, like the Gero-Ed Center, are so important—information on caring for elders needs to become firmly embedded in the social work curriculum.
It is incredibly heartening to see the impact the Hartford Foundation’s 10-year investment in social work has made both on the field of geriatrics generally and on the health of older adults directly—as described in the Foundation’s 2009 Annual Report. Reading the report reminded me of an experience I had while taking a nursing course nearly nine years ago at New York University, when I had my first contact with Dan Gardner, the Hartford Social Work Faculty Scholar featured in the report.
The course, Community Nursing, covered the fundamentals of home care but also required each student to conduct a rigorous health-needs assessment in a specified community. My community assignment was in lower Manhattan and took place soon after the tragic events of 9/11. What I discovered was unexpected—and eye-opening.
First, there were many more older adults than I had expected. High rise apartment buildings on one city block housed nearly 2,000 of them. This was not senior housing. The residents had simply aged in place. Because of this critical mass of older adults, the Visiting Nurse Service of New York had placed a dedicated home care nurse in the community. We, the nursing students, worked with that extraordinary individual and did outreach through the community center.