Conceptualization and Management of Chronic Pain in an Over 65 Using an ACT Lens—A Single Case Study

This single case study illustrates the application and utility of Acceptance and Commitment Therapy (ACT) for a 72-year-old Australian male presenting with chronic pain and complex health conditions. Chronic pain often entails complexity among older adults and can impact the patient’s life across a range of domains. Psychological approaches, as stand-alone or adjunct to medical intervention, are widely acknowledged as potentially beneficial to older persons experiencing pain. ACT has been supported as a viable psychological approach for chronic pain and especially suitable for older persons with chronic pain. This study describes an ACT treatment approach for an older person with chronic pain informed via development of an extension of the existing ACT conceptualization of chronic pain. The development of the ACT based model is in keeping with recommendations to seek out mechanisms of change in psychotherapeutic research. Measures of Quality of Life, Depression, Physical Activity, and Acceptance/Avoidance were taken at pre and post treatment, as well as across treatment phases. Improvement was noted in self-reported measures of QOL, depression, and physical activity.

Recognizing and treating late-life generalized anxiety disorder: distinguishing features and psychosocial treatment

Generalized anxiety disorder is a highly prevalent and under-recognized public health problem associated with significant impairment and serious disability. Generalized anxiety disorder is the most common anxiety disorder among adults over the age of 60 years. This article discusses distinguishing features of generalized anxiety disorder, such as disorder-specific worry domains and associated features. The relation of the disorder to normal aging, major depression and health is also discussed. Current psychosocial treatment strategies are outlined, with a particular focus on cognitive behavior therapy.

The integration of social and psychologic services to improve low-income homebound older adults' access to depression treatment

Despite their high vulnerability to depression, a majority of low-income, homebound older adults face multiple barriers to accessing psychologic services. These older adults require both social services for managing their multiple financial and functional needs and psychologic services for managing their depression. Mental health needs of these older adults may be better met if aging service providers provide both social services and psychotherapy. This study outlines the rationale for integrating the social and psychologic services for homebound older adults and the need for research evidence on the feasibility, efficacy, and replicability of implementing such an integrated model.

Substance abuse treatment initiation among older adults in the GET SMART program: effects of depression and cognitive status

This study examines how individual patient characteristics predict substance abuse treatment initiation among older adults, in an investigation based on the behavioral health service use model. Analyses tested the impact of demographic factors, substance abuse symptoms, depression and cognitive status on subsequent treatment initiation. The sample included 250 older male veterans screened for substance abuse problems during inpatient medical treatment, who also participated in a clinical evaluation for substance abuse treatment. Measures included demographics and CAGE alcohol screening score. A subset of patients also completed the Michigan Alcohol Screening Test-Geriatric Version (MAST-G), Hamilton Depression Scale (HAM-D), and Folstein Mini Mental State Exam (MMSE). Patients who initiated treatment following evaluation had more years of education, better cognitive status, and more symptoms of substance abuse and depression, compared with patients who did not initiate treatment. In logistic regression analysis, CAGE and MMSE scores independently predicted treatment initiation. Findings contribute to the understanding of how clinical characteristics of older adults affect substance abuse treatment initiation.

Psychotherapies and older adults

OBJECTIVE

To confirm clinical experience which suggests that older people are offered psychotherapies significantly less often than younger ones. For those who are able to access psychotherapeutic help the outcome is comparable, sometimes better, than for younger patients.

METHOD

Contemporary and older seminal literature was reviewed for psychodynamic, cognitive-behavioural, reminiscence and systemic family therapies treating older patients.

RESULTS

The main findings supported the experience of staff in old age psychiatry that if the reluctance of referrers and sometimes of older patients themselves can be overcome this type of work is valuable and effective.

CONCLUSIONS

Each patient is unique. Generalizations are not always appropriate, however, with advancing years some common themes emerge in therapeutic work. It may be necessary to make modifications to the therapeutic technique to accommodate the difficulties experienced by people in later life but also to use their strengths. Staff working in this field need to have the capacity to be aware of and to understand their own feelings and prejudices about the second half of life. For patients not offered formal therapy a psychotherapeutic approach will nevertheless enhance their psychiatric care. Although the body of research is growing, more work needs to be done in evaluating all of the psychotherapies offered to older people.

Predictors of alcohol-treatment seeking in a sample of older veterans in the GET SMART program

OBJECTIVES

To examine the predictive value of demographic characteristics and substance abuse indicators to explain treatment seeking for substance abuse problems by older male medical patients.

DESIGN

Longitudinal analysis of screening data and treatment-seeking behavior.

SETTING

Inpatient medical and outpatient substance abuse treatment center.

PARTICIPANTS

Participants in the study were 855 medically ill male veterans aged 55 and older, who were screened for alcohol problems during inpatient medical treatment after clinician referral.

MEASUREMENTS

The CAGE alcohol screen (Cut down on your drinking, Annoyed by criticism of your drinking, Guilty about your drinking, Eye-opener), drug use, and demographic measures administered at time of screening. Predictors of treatment seeking in the sample were examined using structural equation modeling.

RESULTS

Expressed interest in treatment and later attendance at a pretreatment evaluation were associated with younger age and a higher CAGE alcohol screening score. Being unmarried and using drugs in addition to alcohol were associated with treatment interest but not with evaluation attendance. In the path model tested, the effect of higher CAGE score partially explained the effect of younger age on treatment seeking.

CONCLUSION

The model examined shows utility in predicting alcohol-treatment seeking in this sample. Age-related factors may deter treatment seeking by older male medical inpatients.

Guidelines for conducting geropsychotherapy research

Geropsychotherapy researchers have established specific methods that improve the reliability and generalizability of the data from this research. To date, there has been little formal dissemination of these methods. The authors present guidelines for the optimal conduct of psychotherapy research in older adults, which include selection of age-appropriate psychotherapies and control conditions, use of consumer-based methods for recruitment, evaluation of age-related treatment processes and outcomes, and adjusting the research design to accommodate age-specific life events and provide examples of how each guideline was used in their psychotherapy studies. Psychotherapy research with older adults has benefited from methodological advances that improve our ability to ascertain the impact of psychotherapy on late-life disorders. However, the field is still in need of better outcome and process measures, methods for measuring the therapeutic content of non-psychotherapy encounters, and methods for determining the impact of choice of treatment on outcome.

Coping with anxiety in later life

The goal of this study was to determine how older adults cope with three forms of anxiety, and potential avenues for applied interventions. Although the findings shed light on some interesting findings with potential psychosocial applications, several limitations need to be noted. First, this study was based on two assumptions. The assumption, based on earlier work (Carver et al., 1989; Lazarus & Folkman, 1984; Zeidner & Saklofske, 1996), that certain coping strategies are more effective than others, and an assumption of the direction of influence in which anxiety is a precursor of coping strategies. Because this was an exploratory study, the research questions did not directly test these assumptions. Second, this study is correlational in nature. Therefore, conclusions cannot be drawn about the causality of these associations. Third, as with any self-report data and self-selected sample, one needs to interpret the findings with caution. Similarly, for the purposes of the study, a non-clinical sample of older adults was examined using three distinct conceptualizations of anxiety. Suggestions for future research include: Replication of this study using a multidimensional measure of anxiety appropriate for clinical samples. A longitudinal replication of this study identifying patterns of coping that facilitate adjustment over time. Finally, a more general purpose of this study was to focus attention on a neglected issue in gerontology--the experience of anxietY in later life (Frazier & Waid, 1999; Gatz, 1995; Rabins, 1992; Shamoian, 1991; Sheikh, 1992; Smyer, 1995; Stanley & Beck, 1998), and, most importantly, the role of gerontological nurses in early assessment and intervention for successful treatment of anxiety in older adults.