Integrating Mental Health Into Occupational Therapy Practice With Older Adults
Developed by Peter A. Lichtenberg, PhD, ABPP and Catherine L. Lysack, PhD, OT(C), Editors, through funding support to Wayne State University, Institute of Gerontology from the Retirement Research Foundation
Presented by Peter A. Lichtenberg, PhD, ABPP; Catherine L. Lysack, PhD, OT(C); Annmarie Cano, PhD; Gerry E. Conti, PhD, OTR; Allon Goldberg, PhD, PT; Mary Beth O’Connell, PharmD., FCCP; Stacey Schepens, MSc, OTR; Joseph M. Pellerito , PhD, OTR, CDI; Fredrick D. Pociask, PhD, PT, OCS, FAAOMPT
Available from AOTA Continuing Education in collaboration with Wayne State University, Institute of Gerontology, Detroit, Michigan.
Earn .6 AOTA CEU (6 NBCOT PDUs/6 contact hours)
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Order #4859
AOTA Member Price: $152
Nonmember Price: $217
ISBN Number: 978-0-615-26991-7
Recent changes in Medicare reimbursement for therapeutic rehabilitation make it more important than ever for therapists to achieve consistent improvement in older patients so patients can qualify for continued treatment and achieve as full a recovery as possible. Older patients recovering from strokes, heart attacks, falls, lengthy surgeries, and other conditions, however, are at an increased risk for depressed mood, anxiety or confusion that can limit their ability or willingness to participate fully in therapy. When these patients fail to meet rehabilitation goals because they do not practice or exercise as directed, they are often consigned to live their remaining days in institutional settings.
AOTA, in collaboration with the Institute of Gerontology at Wayne State University, is pleased to offer this new 7-hour, modular, DVD-based training program to occupational therapy practitioners to help address these mental health barriers.
Patients can be treated successfully by professionals who recognize the problem and enable patients to get the help they need. The course teaches how to identify and screen for mental health problems, how to motivate seniors who need it to accept mental health care, how to make referrals for care, and how to use their own professional skills to assist in helping patients overcome mental health problems.
A pilot study with 30 occupational therapists showed statistically significant increases in attention to mental health issues. Results are based on comparisons of charting regarding mental health issues on nearly 400 older patients, half treated before the training was given and half treated afterwards. After training, significantly more charts noted that therapists had discussed issues of mood or cognition with patients, completed depression and cognition screenings, and made referrals for mental health care.
Course highlights include
- Overview of aging and mental health, including a review of evidence-based mental health interventions for older adults.
- Review of tools for identifying and screening for mood disorders and problems with cognition.
- Contributions of pharmacotherapy and procedures for referring patients for mental health care.
- Additional modules devoted to teaching therapists how to address fear of falling and driving/driving cessation, and how to support the mental health of family caregivers.
The training program was designed with occupational therapists in mind, but it is relevant for the wide range of therapists and other professionals who work with them in serving this population. A full-day, group training co-sponsored by the Michigan Occupational Therapy Association attracted more than 125 registered occupational therapy practitioners, confirming the importance of this topic and the value of these educational materials to practitioners in the field.
Course Content
- 6 Instructional DVDs
- Learning objectives for each of 6 course modules
- DVD combining all the Assessment Interviews from all the 6 Instructional DVDs
- CD with course operation instruction and supplemental materials
- Complete PowerPoint Presentations
- Patient Assessments
- Reference Lists
Course Description
Module 1: Introduction & Aging and Mental Health
Module 1 provides an overview to therapists about the variability of the aging experience to prevent overestimating disease and disability in community elders. This session focuses first on demography, next on successful aging, followed by a review of ageism and its consequences for elders. The double-jeopardy of being old and having a mood disorder will also be highlighted as will the additional factor of being African American.
Finally, geriatric syndromes will be presented. At the end of this module, therapists will have developed a sensitivity to ensure they do not 'over-pathologize' elders with mood disorders.
Learning Objectives (Module 1)
Upon completion of Introduction & Aging and Mental Health the learner will be able to
- Identify basic geriatric concepts such as comorbidity and incremental assessment
- Identify barriers to older adults receiving care including ageism and stigma
- Identify core symptoms of late life depression
- Identify specific interview questions to assess for mood during history taking
- Recognize the relationship between advancing age and depression and cognitive impairment
Module 2: Understanding and Treating Depression
Module 2 provides an overview about the nature, prevalence, impact, detection and treatment of mood disorders in late life. The syndrome of depression has many etiologies that will be explained in this module. Depression is also frequently accompanied by several comorbid conditions, and especially cognitive impairment. Although the assessment of depressive symptoms can be a straightforward process, some health care providers are uncomfortable discussing mood and well-being with a client. Therefore, this module will result in enhanced provider comfort and basic skills in cognition and depression screening and assessment. The MacNeill-Lichtenberg Decision Tree (MLDT) will be introduced and consists of two brief cognitive tests, a 3-item Geriatric Depression Scale screen and environmental demand questions. The MLDT was developed, validated and cross-validated in medical rehabilitation patients (MacNeill & Lichtenberg, 2000, Bank, MacNeill and Lichtenberg 2003). Using the MLDT will be assigned as homework.
Via case scenarios, occupational therapy practitioners will be able to integrate these new skills into care plans. This model will emphasize non-pharmacologic treatment of depression. Decline in function, activity limitation, behavioral changes, and pleasant events will be reviewed as will specific interventions that can be implemented by therapists. Comorbid issues such as anxiety, sleep and dietary concerns will also be addressed.
Learning Objectives (Module 2)
Upon completion of Understanding and Treating Depression the learner will be able to:
- Identify 4 biopsychosocial causes of depression
- Identify the clinical properties of the Geriatric Depression Scale (GDS)
- Identify the clinical properties of the MacNeill Lichtenberg Decision Tree (MLDT)
- Identify the cognitive test difficulties of Mr. Dyer
- Recognize the false positive screen for depression with Mr. Tayhill
Module 3: Medications and Depression: Treatments and Consequences
Frail older adults represent one of the most difficult groups of clients to treat for depression. The presence of comorbid diseases, especially Alzheimer's disease and pain, polypharmacy and social and financial issues often lead to a complex clinical picture.
In addition to learning when to refer for treatment evaluation for mood disorder, therapists will also learn basic pharmacological principles including efficacy and toxicity about antidepressant medications and the elderly. Therapists will not only be able to recognize common medication side effects and adherence problems but for some of these problems they will be able to develop and implement a plan to resolve side effects and improve adherence. Recognition of substance abuse and medication-induced depression will also be covered. The Michigan Alcohol Screening Test-Geriatric version will be introduced to the trainees with instructions on how to use the scale when suspicions arise.
Learning Objectives (Module 3)
Upon completion of Medications and Depression: Treatments and Consequences the learner will be able to:
- Identify the basic impact of antidepressionants on neurotransmitter substances during cellular communication
- Select single questions to ask about physical and mental health
- Recognize how to explain to a patient the role and duration of use for antidepressants.
- Identify and resolve problems causing non-adherence to drug treatment for depression
- Identify the clinical properties of the Alcohol Use and Disorders Identification Test (AUDIT)
Module 4: Family Cargiving
Therapists often provide an important connection from the health community to the informal support system of the client; often the family caregiver. Family caregivers are typically viewed only as a resource for clients, and their burden and stress is often not well understood by health professionals. Therapists will learn the details of the caregiving experience, including the warning signs of significant caregiver distress and burden. Basic skills in caregiver strain and burden assessment will be developed. Indeed, the Caregiver strain index will be used because of its specificity to impacts on the caregiver after a hospitalization has occurred in the care-recipient. African American caregivers often experience more competing stresses and have access to less community resources than do European American caregivers. Therapists will also learn to recognize and assist with the normal healing process related to loss and grief.
Learning Objectives (Module 4)
Upon completion of Family Caregiving the learner will be able to:
- Delineate the numbers and gender ratios of informal (i.e., Family or friends) caregivers to American adults
- Identify the prevalence of depression in caregivers compared to the general population
- Identify the top 3 ways that caregiving impacts the caregivers’ lives
- Identify the clinical properties of the Caregiver Reaction Assessment instrument
- Determine when caregivers and patients might benefit from additional support through the use of observation and targeted questions
Module 5: Falls, Balance and Exercise
Home safety, safe mobility and physical fitness are integral parts of the therapists' treatment for physically ill and homebound elders. The impact of mood disorders on injurious falling, exercise participation and pain experience will be delineated.
Specific balance, gait, fall, and home assessment and efficacy scales will be introduced as well as specific strategies to increase involvement by depressed clients to increase home safety, improve mobility and minimize falls. The Activities Balance Confidence scale will be demonstrated.
Learning Objectives (Module 5)
Upon completion of Falls, Balance and Exercise the learner will be able to:
- Recognize how balance confidence may impact an older adult’s balance and ability to perform daily tasks
- Identify the clinical properties of the short version of the Activities-Specific Balance Confidence Scale (i.e., the ABC-6)
- Identify the command centers in situational awareness
- Identify at least 2 of Ruth’s behaviors associated with loss of center of balance
- Identify the association between depression and balance and falls
Module 6: Driving and Community Mobility
This module focuses on the ability of frail and/or home bound older adults to be mobile in their homes and neighborhoods but also refers to their ability to participate more broadly in meaningful activities with other people. Disability brings considerable limitations to physical mobility which calls for specialized assessments regarding seating and mobility and technical equipment to enable desired mobility and social involvement.
Assessments and interventions related to driving cessation is a key concern. For home bound adults and those recovering from a disability, alternative methods of transportation must be explored. So, too, must new communication technologies. Today, there are voice-activated environmental control systems for the home and computer-based communication tools that permit participation in virtual support groups and the pursuit of leisure interests 'remotely'. This module will explore a range of tools to facilitate increased physical and social participation.
Learning Objectives (Module 6)
Upon completion of Driving and Community Mobility the learner will be able to:
- Identify key crash statistics that distinguish between younger and older drivers
- Identify two mental health disorders affecting safe driving
- Identify the driving retirement process
- Identify two alternative modes of transportation for older adults who do not drive
- Determine at least two questions to identify driving problems
AOTA Occupational Therapy Classification Code for Continuing Education
Category 1: Domain of Occupational Therapy, Client Factors
Category 2: Occupational Therapy Process, Evaluation and Intervention
Learning Level: Intermediate
Target Audience: Occupational Therapists and Occupational Therapy Assistants
CE Credit Exam and Certificate
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