Thirty years is a very long time, especially when one is in a committed relationship.
Most marriages now-a-days don’t even last that long. According to one of the definitions in Webster’s New World Second College Edition Dictionary, a commitment is “a pledge or promise to do something.” That definition pretty much sums up the John A. Hartford Foundation’s work over the past 30 years in trying to improve the health care of older adults here in the United States.
More than three decades ago, the Foundation was in transition, trying to find the next big area to fund that would “do the greatest good for the greatest number,” a philosophy adopted by John A. Hartford, his brother George L. Hartford, and the Trustees of the Foundation charged with seeing this vision to fruition.
Elizabeth’s inspiring story of how she overcame years of depression triggered by the murder of her daughter and subsequent death of her husband is featured in our 2011 annual report video series.
The release earlier this month of our second national poll, “Silver and Blue: The Unfinished Business of Mental Health and Older Americans,” capped a year in which the John A. Hartford Foundation has focused a spotlight on mental health issues.
We made mental health and older adults the focus of our award-winning 2011 annual report, and we brought the stories of real people we told in the pages of the report to life in a series of captivating videos that ran throughout the fall.
In this final installment of our 2011 Annual Report series, we are pleased to share the voice of those who are too often overlooked—the family caregiver. This video features Mignonne, daughter of 82-year-old Roberto; she speaks candidly about her father’s delirium and the impact it had on both of their lives.
Delirium is a sudden, fluctuating, and usually reversible state of mental confusion that affects up to 50 percent of hospitalized older adults. People with delirium may present as disoriented and have memory problems. As a result, they are often misdiagnosed with dementia, depression, or psychosis.
David has bipolar disorder, and for years has participated in and even collaborated on studies conducted by Colin A. Depp, PhD, an assistant professor at the University of California, San Diego Hartford Center of Excellence in Geriatric Psychiatry. In the latest installment of our 2011 Hartford Foundation Annual Report video blog series, there is an extraordinary moment where David discusses the importance of the work that Depp and others at the center are doing.
“I’m not a number. I’m not a statistic. I’m me,” David says. “And we need people like them to deal with the me’s.”
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.