Managing Hypochondriasis in Elderly Clients

The present paper provides a diagnostic and treatment overview of geriatric hypochondriasis. It is suggested that our current definition of hypochondriasis may be inadequate in describing the complexity of the disorder and its varied manifestations in the general population and especially in our geriatric population. Attempts by researchers to provide greater diagnostic clarity are reviewed, including the concepts of hypochondriasis as a discrete disorder (primary hypochondriasis) and hypochondriasis as part of a comorbid mix of disorders (secondary hypochondriasis). Diagnostic features of geriatric hypochondriasis are discussed, including comorbidity, prevalence, the relationship of medical illness to hypochondriacal symptomatology, and etiology. Treatment considerations which are reviewed include: the importance of respect for the defenses of the client, the importance of venting and expressions of feeling by the client, the creation of a psychological atmosphere of professional and interpersonal support, and reattribution training. It is suggested that hypochondriasis is a social “communication” and that comorbidity itself may be the key to unlocking the unspoken “messages” of hypochondriacal older adults.     

Elder Abuse: Ethical and Related Considerations for Professionals in Psychology

Elder abuse presents difficult ethical considerations that the field of psychology has yet to sufficiently address. As demographics and sociocultural factors shift in the coming decade, this deficit in ethical competence may become an increasingly serious problem. Although legal definitions of elder abuse lack uniformity and clarity, there is much room for improvement in the field of psychology. Ethical considerations most relevant to professionals in psychology draw heavily on the principles of beneficence and nonmaleficence and respect for people's rights and dignity. Professional standards of competence, discrimination, informed consent, privacy and confidentiality, and cooperation with other professionals are also critical in these considerations. A number of recommendations are made, centering around the needs for more education, frank discussion, and empirical examination of the complexities of elder abuse.     

老龄活体供肾移植的临床应用

为缓解供体器官的严重短缺,老龄活体供肾移植逐渐成为一种可以接受的对策。老龄活体供肾移植有其特殊性并且更易于引发伦理争论。本文简要介绍此问题的研究现状,并就若干社会伦理学问题展开讨论。     

老年舒张性心力衰竭诊治的思考

舒张性心力衰竭在老年高血压、冠心病患者中发病率较高,但临床症状、体征不特异,不典型,常容易漏诊。因此,临床工作中应注意发现舒张性心力衰竭相关的症状、体征,结合胸片有肺淤血、超声心动图左室射血分数(left ventriculare-jection fraction,LVEF)正常、血浆脑钠肽(brain natriuretic peptide,BNP)增高等,早期诊断及治疗,提高老年患者的生活质量,减少晚期混合型心力衰竭的发病率。     

Balancing Elder Care Responsibilities and Work: The Impact on Emotional Health

The current study investigated the effects of balancing elder care and work on emotional health. Responses from 43 retired caregivers, 211 not retired caregivers, 49 retired non-caregivers, and 224 not retired non-caregivers, who had participated in the national Health and Retirement Study, served as the data base. Results indicate that Caregiver Status (Caregiver vs. Non-caregiver) and Retirement Status (Retired vs. Not Retired) interact, depending on the measure of emotional health. The relationship between the number of depression symptoms reported and Caregiver Status depended on whether the respondent was also retired or employed; a significant interaction was not found when emotional health was measured with one overall item. A significant difference was not found between employed caregivers and employed non-caregivers, in terms of emotional health. Employed caregivers who gave more caregiving hours did report poorer emotional health than employed caregivers who gave fewer hours. Female caregivers reported more depression symptoms than male caregivers. The results suggest that employers may need to develop interventions which may help caregivers who are highly involved with caregiving responsibilities.     

Workplace Violence and Worker Injury in Elderly Care Settings

Abstract

Many incidents of injury, assault, and abuse occur in health care settings. To better examine the situational context of the workplace, this paper examines whether workers providing care to elderly persons experience injuries that are consistent with the “for-profit” and “interpersonal conflict” explanations of elder abuse or neglect. Using data from the Bureau of Labor Statistics, results indicate that nursing home workers and home health care workers have higher rates of workplace injuries resulting from assaults and overexertion than do other workers. The data suggest that there are unique structural and situational factors present in the nursing home, which create a work setting vulnerable to conflict, violence, and elder abuse.     

Intimacy and Complicated Grief among Chinese Elders Having Lost their Spouses: Mediating Role of Meaning Making

This study aims to investigate the mediating role of meaning making in the relationship between intimacy and complicated grief among bereaved elders. A sample of 352 bereaved elders in rural China participated in the study. Both the linear and quadratic effects of meaning making illustrated a model that mediated the effect of intimacy on complicated grief. Essentially, findings revealed that only high levels of meaning making predicted low levels of complicated grief. This study thereby supplements existing research about meaning-making theory.     

我国非瓣膜病房颤抗凝的现状与思考

心房纤颤增加缺血性脑中风4倍～5倍,抗凝治疗可减少60％的缺血性脑中风,但是同时会增加出血的风险,尤其是脑出血。我国是脑中风,特别是出血性脑中风的高发国家,所以对于房颤抗凝的临床决策往往偏保守,造成我国房颤患者抗凝比例很低。本文就如何在我国房颤患者中进行抗凝提出意见。     

Association of Depressive Symptomatology and Elder Mistreatment in a U.S. Chinese Population: Findings From a Community-Based Participatory Research Study

Elder mistreatment (EM) is associated with increased morbidity and mortality. The objective of this study is to examine the association between depressive symptoms and EM in a U.S. Chinese population. A community-based participatory research approach was implemented to partner with the Chicago Chinatown population. Self-reported EM was assessed using a modified Vulnerability to Abuse Screening Scale instrument. Depressive symptomatology was assessed using the short form Geriatric Depression Scale. Exact logistic regression was used to assess these associations. Of the 78 participants, mean age was 74.8 (SD = 7.8) years and 52.6% were women. EM was reported in 20.5% of participants. After adjusting for potential confounding factors, higher numbers of depressive symptoms were independently associated with increased risk of EM (Exact OR, 1.99, 95% CI [1.23, 3.41]). Interaction terms analyses suggest that higher educational levels might buffer the risk of EM associated with depressive symptoms. Longitudinal studies are needed to confirm these findings in this U.S. Chinese population.     

关注老年癌症止痛

虽然肿瘤的发病率在老年人并不低,但社会对老年人的关注度并不高。几乎所有肿瘤药物临床试验都把老年人排除在外,因此,不少药品说明书特别注明“缺乏老年人资料”。老年癌痛治疗领域也存在同样的问题。老年癌痛的病理生理及心理特点很独特,加之对老年癌病重视不够及缺乏正确评价,所以老年癌痛的研究相当复杂,因而癌痛的处理犹如癌症一样也需要综合治疗。癌痛治疗药物可分成两大类：非阿片类及阿片类药物。非阿片类药物中首选对乙酰氨基酚治疗轻度癌痛,非甾体类抗炎药,特别是选择性COX2抑制剂可在对乙酰氨基酚无效时应用。阿片类药物则广泛应用于中度到重度的癌痛治疗。辅助治疗药物包括三环抗抑郁药、抗惊厥药、苯二氮蕈类药物等。可用于癌痛三阶梯治疗的任一阶段,能够治疗特殊类型疼痛,改善癌痛以外的症状,增加主要药物镇痛效果,减轻副作用,但不推荐常规使用。总而言之,对于老年癌症患者更要强调以镇痛为主的姑息治疗,特别在重症老年患者,可能成为最重要的治疗,有时甚至是唯一有效妁治疗。     

Self-Reported Abuse and Mistreatment among Japanese Elders Receiving Respite Care

This study examines physical and psychological mistreatment reported by Japanese elders who received care from family members. Data is based on structured face-to-face interviews with community-dwelling elders who utilized respite care services. Among the 118 elderly respondents, 12% reported being hit or almost being hit by their caregivers. Close to 54% reported at least one type of psychological mistreatment. Men who received care from their spouses were most likely to report abuse. Elders who were victimized reported increased levels of depressive symptoms. Logistic regression analyses indicated associations between physical abuse and past conflicts with the caregiver. Psychological mistreatment was associated with receiving care from a spouse, past conflicts with the primary caregiver, and depression. The findings suggest the need for increased awareness of the needs of community-dwelling Japanese elders who are at risk for abuse, mistreatment, and depression.     

Family Violence and Health Among Elderly in Croatia

This article presents the research carried out on a sample of 303 elderly men and women. In the last year they reported experiencing violence in the family as follows: psychological abuse (24.1%), financial exploitation (6.4%), physical abuse (4.4%), and sexual abuse (2.1%). The abusers were most often husbands (30.15%), sons (16.64%), daughters (14.01%), and wives (9.21%). In the partner relationship, 44%?of the women and 35%?of the men had experienced at least some form of violence. The results showed that elderly men and women who were victims of family abuse had poorer psychological health than those without such experiences. Elderly who had experienced partner violence consumed alcohol more often than those who had experienced violence by other household members.     

The Culture-Embedded Social Problem of Elder Mistreatment: A Review of International Literature on Asian Elders

Elder mistreatment is now recognized as a worldwide social problem occurring in all racial and ethnic groups. The research on elder mistreatment started in the late 1970s and expanded its focus to ethnic elderly groups including Asian elders in the mid-1980s. Many researchers have explored the issues of elder mistreatment in conjunction with Asian elders’ culture and immigration backgrounds. This article reviews the state of the literature on elder mistreatment among Asians living in Asia or abroad to identify future directions of research, prevention, intervention, and policy. This research indicates that prevention, education, and intervention must take into account the cultural backgrounds of Asian elders and their family members. There is clearly a need for greater research into appropriate elder mistreatment prevention and intervention with Asian elders and their family members.     

Elder Mistreatment among Chinese and Korean Immigrants: The Roles of Sociocultural Contexts on Perceptions and Help-Seeking Behaviors

The purpose of this study was to identify dimensions of elder mistreatment in Chinese and Korean immigrant communities and to increase sociocultural understanding of such mistreatment by elucidating the complexities of abuse embedded in unique social and cultural contexts. In-depth interviews were conducted with 20 local professionals working primarily in Asian elderly advocacy, and six focus group discussions were conducted involving 60 community members in the San Francisco Bay area. Five dimensions of elder mistreatment were identified: psychological abuse, neglect by a trusted person, financial exploitation, physical abuse, and sexual abuse. In general, fewer Korean community member participants reported having observed physical or financial abuse than Chinese groups, but they reported greater knowledge of situations involving psychological abuse, neglect by a trusted person, and sexual abuse. The contexts of cultural influences and immigration and acculturation were salient themes that shaped participants’ subjective perceptions and beliefs about elder abuse and hence help-seeking behaviors.     

Etiology and Management of Elder Self‐Neglect

This article addresses the challenges of defining and accurately identifying elder self‐neglect and explores an interdisciplinary team model, including counselors and mental health professionals, designed to implement prevention and intervention strategies. The challenge of striking a balance between the need to respect the individual elders' autonomy and the need to attend to their health care needs is underscored.     

Protecting older adults in the Israeli health system: Cross-cultural interactions involved in legal and social elder abuse interventions

ABSTRACT

In 2002 the World Health Organization published a categorical definition of “Elder Abuse,” but the relevant social and legal interventions differ markedly even among Western-oriented countries. This article compares and contrasts approaches to this widespread and very serious problem in the New York City and the Israeli health-care systems. In today’s world, the members of a family do not all necessarily live on the same continent, so professionals must be aware of the way things are done in countries other than their own. The differences in the interventions employed, or not employed, in these two specific systems highlight the need to understand not only how elder abuse is dealt with in each place, but the conceptual framework that governs it. The present article can serve as a guide for American professionals and others concerned with the problems of elder abuse who function within the Israeli health care system.     

Respect for Elders: Myths and Realities in East Asia

The trend in East Asia from authoritarian and patriarchal relationships to egalitarian and reciprocal patterns of mutual respect between generations is eroding the willingness of younger generations to respect the elderly in traditional ways. Have the Confucian teachings on respect for elders become myths? This article reviews traditional ways of treating parents and elders prescribed in Confucian literature and examines how they are expressed in modern times.     

Older adult research in the Journal of Counseling Psychology,The Counseling Psychologist,and Counselling Psychology Quarterly: A 15-year review and implications for research

In preparing for an aging global population, older adults’ well-being has become an urgent priority across the world. Counseling psychologists have also called upon the field for more empirical attention on older adults. Yet, a review of the literature revealed that older adults were represented in less than 2% of all the articles in the Journal of Counseling Psychology (JCP) and The Counseling Psychologist (TCP) from 1991 to 2000. The current study presents a follow-up review of older adult research in counseling psychology literature between 2001 and 2015 in the following mainstream journals: Counselling Psychology Quarterly (CPQ), JCP, and TCQ. Results suggest a decline in the past 15 years, with less than 1% of the total articles in JCP, TCP, and CPQ devoted to older adults. Most of the studies employed cross-sectional survey research design to examine predictors of mental health. A number of studies focused on culture-specific experiences of diverse older adults. Implications and suggestions for future research on older adult issues are discussed in relation to the principles and interests rooted in the field of counseling psychology.     

Domestic Abuse Across the Lifespan

ABSTRACT

Domestic abuse has reached epidemic proportions in the United States. Occupational therapists working in many different settings will encounter children, adults, elders and individuals with disabilities who have experienced intimate violence and abuse. This article presents common definitions and illustrative examples of each type of violence. Issues related to the difficulty inherent in identifying victims of abuse are discussed with an elaboration of indicators that are likely to be seen by an occupational therapist in the clinical setting. Risk factors for becoming a victim or an abuser for each population group and the effects of violence on victims are presented. A brief discussion of the legal and ethical implications of identifying and treating abuse victims concludes the article.