Health AGEnda

Roberto’s Story: Giving Voice to Family Caregivers

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.

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Educating Nurses about Mental Health and Aging

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.

It happened to Nora OBrien-Suric’s father and Chris Langston’s uncle. It also happened to Roberto, whom we feature in our 2011 Hartford Foundation Annual Report. All of them had delirium, a reversible condition that can affect older adults after surgery or an illness.

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.

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Joining the Quest for Improved Health Care

From left: the author, her grandmother, and her brother, Nick

It is a pleasure to introduce myself as a new member of the John A. Hartford Foundation staff. In the brief two months that I have been with the Foundation, I have felt overwhelmingly inspired by the dedication and passion of my colleagues and the tremendous amount of progress made by the Foundation’s grantees toward our shared mission of improving the health of older Americans.

As a California native, I came to New York City fresh out of undergraduate education at UC Santa Barbara and jumped into management consulting for nonprofit and philanthropic organizations. This work introduced me to the importance of philanthropy as an agent for social change. Prior to joining the Foundation, I worked with the New York City Department of Health and Mental Hygiene’s Primary Care Information Project (PCIP). This Mayoral Initiative seeks to improve the quality of care in underserved communities through the use of health information technology (HIT) and helps NYC primary care providers achieve “Meaningful Use” as defined by the federal government. My work with PCIP introduced me to the lack of and the need for patient-centeredness and care transitions, which are vital to improving health care delivery and reducing costs. At PCIP, I began focusing my career on improving the quality of health care for all Americans.

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Improving Mental Health Nursing Care for Older Adults

Older adults suffer from mental health problems at greater rates than younger adults, particularly the three “Ds”: depression, dementia, and delirium. Yet there are very few geropsychiatric nurses in the United States and no formal credentialing for the field. To address this gap in our health care system, the John A. Hartford Foundation has supported the American Academy of Nursing’s Geropsychiatric Nursing Collaborative. The goal of the initiative is to improve the quality of mental health care provided to older adults by enhancing the knowledge and skills of nurses. To do this, the Hartford Geropsychiatric Nursing Collaborative has created and disseminated core geropsychiatric competencies and curricular materials tailored to all levels of nursing education.

Last month, Medscape Medical News interviewed Lois Evans, PhD, RN—one of the Geropsychiatric Nursing Collaborative’s principal investigators (along with Kathleen Buckwalter, PhD, RN and Cornelia Beck, PhD, RN)—about available resources to improve mental health nursing for older adults. You can read the interview here with a free registration on Medscape. An additional geropsych resource of note is a recent webinar hosted by the American Association of Colleges of Nursing in partnership with the Geropsychiatric Nursing Collaborative on how to utilize their resources and infuse geropsychiatric content into nursing curricula. Information is available here, with a recording of the webinar soon to follow.

Anyone with an interest in geropsychiatric resources should check out not only the interview and webinar, but also the extensive collection of geropsychiatric nursing curriculum materials available on POGOe, the Portal of Online Geriatric Education. The more nurses we reach, the more we can improve mental health care of older adults.

Now Hear (and See and Use) This: New Geropsychiatric Nursing Video

Here are two truths:

About 1 in 5 older adults (7.5 million) currently has a diagnosable mental disorder such as depression or dementia, and this number is expected to reach 15 million by 2030.

The nation’s 3 million registered nurses represent the largest segment of the professional health care workforce providing care for older adults.

This reality makes the work of geropsychiatric nurses invaluable.  Yet, despite this need, only 16% of psychiatric nurses have subspecialty preparation in geriatrics.

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