Archive for “EFLI” Categories

Elder’s Family Learning Initiative: Anticipate the Possible Anxiety Interventions

By Kimberly Fuson, Chief Program Officer and member of the Elder’s Family Learning Initiative project team

Robison Jewish Health Center frontIf your loved one suffers from anxiety, the care team may employ intervention(s) from one or more of three categories: directive, non-directive, and pharmacological.

While it is important to have working knowledge of each approach, it may be more important to remember that each client needs to be treated as a unique individual; interventions need to be unique to the client. We may need to go at a slower pace with older clients, be more patient with progress, take more time to assure understanding of technique(s) and that a combination of the three following types of interventions may need to be used at the same time or perhaps consecutively to optimize opportunity for best outcomes.

Directive Therapies

The social worker leads process, gives client instruction on how to deal with problems. Interventions include:

  • Relaxation/Exposure – Involves confronting the issue, then learning techniques such as yoga breathing to reduce anxieties;
  • Cognitive Restructuring/Reframing – Often used along with exposure, this technique focuses on challenging the client to stop worrying and replace worry thoughts with positive thoughts; used for general anxiety.

Non-Directive Therapies

Client leads the process; the social worker listens more and focuses on client strengths. Interventions include:

  • Coping Strategies – Emphasize individual strengths and successes; destigmatize issues; encourage client’s feeling of control over their environment; or encourage client to translate skills to different potential situations. Social workers must know cultural influences to be used effectively.
  • Supportive Psychotherapy – Techniques support talking about and through existential issues such as meaning of one’s life and death. Sharing creates a relationship and caring through empathic listening and minimizing feelings of isolation and loneliness. Studies show that nearly twice as many anxious older people respond to supportive therapy versus cognitive behavioral techniques.
  • Specific Worry Technique – Teaches the older client to yell at themselves to stop whenever they begin to dwell on a worrying issue or create a specific time period each day when worrying is permitted.

Psychopharmacology

Medication is, unfortunately, most often the first line of treatment due to the somatic or psychosomatic nature of older adults’ presentation of anxiety. Ninety-five percent of benzodiazepine prescriptions in this country are ordered for older adults with anxiety, many of whom live in nursing homes. Before prescribing medications social workers must advocate for and participate in comprehensive assessment for our clients.

Source: Virginia E. Richardson and Amanda Barusch, “Gerontological Practice for the 21st Century: A Social Work Perspective”, New York, Columbia University Press 2006

Support our effort to help people prepare for their involvement in the long-term care system–donate online now. Thank you for your generosity!

Elder’s Family Learning Initiative: Know the Causes of Anxiety in Older Adults

By Kimberly Fuson, Chief Program Officer and member of the Elder’s Family Learning Initiative project team

Robison Jewish Health Center frontUnderstanding the causes of your loved one’s anxiety will go a long way toward alleviating the pressure on your and your family.

Causes of anxiety and related disorders in older adults can be divided into two categories: biological and psychological/social.

Biological Causes of Anxiety

Social workers should be vigilant in assisting and serving geriatric clients to determine any biological sources of anxiety.

Social workers can assist clients by determining normative anxious responses to medical problems such as Chronic Obstructive Pulmonary Disease (imagine not being able to “catch your breath for the rest of your natural life) and dementia, especially in its early stages (imagine how it would be if you knew you didn’t know things and you could never get that recall back, knowing this would continue and worsen over time).

Additional important factors include ruling out medication reactions or side effects, and other psychiatric conditions, especially depression and delirium which are often present at the same time and may mask or be mistaken for anxiety.

Psychological and Social Causes of Anxiety

Psychological and social causes of anxiety in older adults have to do with of life events. Loss in younger adulthood is related to growth and development and celebrated as such, while loss in old age includes youth, spouse, and independence which are not. The older adult’s life experiences exponentially outweigh those of younger adults, and cumulative losses can trigger anxiety in older adults. Thoughts of not being able to manage financial resources, outliving financial resources or catastrophic loss of financial resources may also trigger anxiety in the older adult. These anxieties are most often realistic in nature, stemming from extraordinarily intimidating circumstances.

Assessment must be holistic and comprehensive in nature. There are few tools to assess anxiety in older adults and those that exist are limited in their ability to address cultural and gender diversity. Attention to language seems to be a key with the current older adult population. Using variations of the word “worry” as opposed to “anxiety” appears to open the door to discussion and exploration of issues with older adults. One tool designed specifically for older adults that works extraordinarily well is the short version of the Penn State Worry Questionnaire.

Source: Virginia E. Richardson and Amanda Barusch, “Gerontological Practice for the 21st Century: A Social Work Perspective”, New York, Columbia University Press 2006

Support our effort to help people prepare for their involvement in the long-term care system–donate online now. Thank you for your generosity!

Elder’s Family Learning Initiative: Understand Anxiety in Older Adults

By Kimberly Fuson, Chief Program Officer and member of the Elder’s Family Learning Initiative project team

Robison Jewish Health Center frontUnderstanding anxiety in older adults will help family members better manage the care for their loved one.

Anxiety and related disorders in the older adult are grossly underestimated, difficult to diagnose, and different in cause and presentation from those of younger adults. This is due to several factors:

  • The older adult’s stigma regarding acknowledgement of a “mental health” issue. This is changing rapidly with the ascendance of the Boomer cohort in Western society.
  • Somatization in older adults that complicates accurate professional diagnosis, i.e. measurable high blood pressure
  • Psychosomatization that complicates accurate professional diagnosis, i.e. expression of not feeling well that cannot be linked to any medical diagnosis
  • Multi-pharmacology, related side-effects and potential misuse/abuse. Older adults may take more medications and therefore be more susceptible to misuse or abuse. Additionally, the older adult cannot absorb the same dosage as younger adults and can experience greater degree of side effects.
  • Life experience may enhance older adults coping or masking skills;
  • Health professionals’ lack of knowledge, tools and holistic approach to mental health issues with the older adult population;
  • Interpretation and definition of “losses” and reduction of celebration of those “losses”
  • Health professionals’ lack of knowledge and appreciation of cultural expression of anxiety;
  • Older adults’ greater propensity to suffer from “health impairments” generally.

In the next post we’ll look at biological and psychological causes of anxiety in older adults.

Source: Virginia E. Richardson and Amanda Barusch, “Gerontological Practice for the 21st Century: A Social Work Perspective”, New York, Columbia University Press 2006

Support our effort to help people prepare for their involvement in the long-term care system–donate online now. Thank you for your generosity!

Elder’s Family Learning Initiative: Write an Ethical Will

By David Molko, staff therapist at Jewish Family & Child Service

Robison Jewish Health Center frontI have had the privilege of working with many of the residents at Rose Schnitzer Manor in my capacity as the facilitator of a group that we have titled, Mindfulness in Aging. The group has explored and discussed the challenges we face as we age. The issue is how we continue to derive meaning and purpose in our lives. One tool that has proven to be helpful in this process is the development of an Ethical Will.

Though its historical routes lie firmly in Jewish traditions and values-in truth, an Ethical Will really does transcend the bounds of any particular religious persuasion. This document can form the foundation for discovering hidden truths about yourself or family, be a way of better understanding how you became the person you are, and provide a template for gaining a clearer view of the legacy that you want to leave behind. Unlike a traditional will, an Ethical Will provides the writer an opportunity to reflect on life’s achievements as well as a time to reflect about those values and ideals that helped to shape their lives. Many of us have live through momentous changes in the world. Recording your participation in these events, or the way in which you were affected by them, creates living memories- stories that will be handed down from generation to generation.

Why create an ethical will? There are many reasons. The following is just a sample list:

  • We all want to be remembered, and we all will leave something behind.
  • It helps you identify what you value most and what you stand for.
  • By articulating what we value now, we can take steps to insure the continuation of those values for future generation.
  • It helps coming to terms with our mortality by creating something of meaning that will live on after we are gone.

In beginning the process of writing an Ethical Will you may want to consider some of the following to help start the process:

  1. People who had the biggest impact on who I am as a person and why.
  2. From my grandparents learned that…
  3. From my parents I learned that…
  4. From my spouse /children I learned that…
  5. I am grateful for…
  6. My most meaningful religious/spiritual/holiday tradition is…

Benjamin Franklin said, “The doors of wisdom are never shut.” The development of an Ethical Will can provide a portal through which wisdom and insight, amassed over a life time, has an opportunity to gain form and substance.

Consider supporting our effort to help people prepare for their involvement in the long-term care system. Donate online now. Thank you for your generosity!

Elder’s Family Learning Initiative: Keep an Open Mind

By Peter Korchnak, Online Communications Manager

Robison Jewish Health Center frontBefore joining the Cedar Sinai Park team in April 2011, I had no connection to the long-term care system. My parents and both sets of parents-in-law are in their sixties, my only surviving grandmother is aging at home, as is the custom in my homeland Slovakia, and I’d only worked in organizations dealing with social ills. With that background, the most important thing I’ve learned so far is: elder care is complicated and to get the best out of it you need to keep an open mind.

There’s a lot to consider in long-term care. So far in this blog series, you’ve learned to learn from others, use your contact person to navigate long-term care, separate perception from reality, and prepare for some of the powerful emotions you’ll be experiencing. These are all just as valuable for a family member as they are for an employee: I’m learning from others every day; I’ve had to adjust my preconceived notions about nursing homes; and I’ve become stronger emotionally as well. All along, I’ve also had to crack my mind open wider and wider.

Six months into the job I know my learning has just started and that it goes beyond the good old, “You learn something new every day.” You experience something new every day; in long-term care, sometimes those experiences will be joyful and other times they’ll be challenging. The Elder’s Family Learning Initiative course book “Guide to Care for an Aging Parent” is 49 pages long. It could as well have been 490 pages were direct experience not superior to facts for learning. Some things you just won’t know until you go through them in person.

My supervisor likes to say that we work where our residents live. Just as working here is a new phase in my life, having a loved one transition to long-term care may be a new stage in yours. Think of an open mind as a great tool for successfully facing challenges in every life stage, including long-term care.

Consider supporting our effort to help people prepare for their involvement in the long-term care system. Donate online now. Thank you for your generosity!

Elder’s Family Learning Initiative: Prepare Emotionally

By Lesley Sacks, Social Services Co-Director at Robison Jewish Health Center

Robison Jewish Health Center frontThroughout the 7 years I’ve worked at Robison Jewish Health Center at Cedar Sinai Park, I’ve had a half a dozen family members live here. In addition to working with residents’ family members, the experience has also given me an insight into the challenges of having a loved one living here. I have seen first hand how unfamiliar both residents and their family members are with all the nuances, issues, and choices involved in long-term care. The greatest challenge, however, isn’t getting all the necessary information, it’s emotional preparedness.

No one is really ever prepared, emotionally or psychologically, for involvement with the long-term care system, but if you have a sense of what’s in store and what kind of emotions you might encounter, it will be helpful.

One of the greatest emotions family members experience is guilt, and a lot of other emotions tie into it: guilt you aren’t able to do more for your loved one, to take care of him or her yourself; guilt that you weren’t good enough to do it yourself;  or simply guilt for just having a loved on in an elder-care facility.

Another significant emotion is frustration: with yourself for not being able to take care of your loved one; with the loved one because of how much caregiving has altered your life; with having to place the loved one in a nursing home, which in turn triggers guilt.

Still another common emotion is the stress of having to take a stand against your parent’s wish to stay at home, even if they can no longer do that safely. Yet another is a sense of loss, particularly if your loved one suffers from dementia or other cognitive problems; as you watch your loved one deteriorate in front of your eyes, you can experience the same stages of grief and loss as if they have already passed away.

Preparing for these powerful emotions and talking about them with your main contact person in the elder-care system, be it a social worker or resident care manager, can provide you with the foundation and support for managing the transition to long-term care. This is the purpose of the Elder’s Family Learning Initiative.

Consider supporting our effort to help people prepare for their involvement in the long-term care system. Donate online now. Thank you for your generosity!