Opportunities for development via group psychotherapy in the nursing home

This paper illustrates the benefits of group therapy within the nursing home, and considers the enhancing and problematic factors in conducting groups within this setting. Growth which empowers staff and residents is possible and can be achieved despite significant challenges and social change. A lifespan developmental perspective can assist residents to achieve their maximum developmental maturity and group therapy can be effective in accomplishing that goal. This paper discusses the effect of the nursing home environment and staff on the resident, the task of the therapist in the nursing home, the value of group therapy, therapeutic goals in group therapy, what precipitates the need for group therapy in nursing homes, and the issue of group therapy with the cognitively impaired.     

Rationale for Individualizing Interventions to Promote Adjustment to the Nursing Home

This study was designed to determine whether certain variables were predictors of nursing home residents' membership in groups representing qualitative categories of nursing home adjustment. Responses of 186 residents to an open-ended question about how they handled the change to nursing home life were coded as very good, fair, or poor; an adjustment variable was created on the basis of this classification. Analysis of variance of random samples from each adjustment group showed that affect and social support varied significantly with adjustment. However, when discriminant analysis was applied, the three groups could not be differentiated using measure of affect, life satisfaction, social support, participation in the decisions leading to admission, nursing home satisfaction, or health. Based on the conclusion that adjustment to the nursing home is a unique experience for each individual, strategies were proposed for individualizing interventions to enable adjustment.     

MANAGEMENT OF GERIATRIC INCONTINENCE IN NURSING HOMES

A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures. The primary components of the system were prompting and contingent social approval/disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45%. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings.     

DERIVED IDENTITY AND DEPRESSIVE SYMPTOMATOLOGY IN WOMEN DIFFERING IN MARITAL AND EMPLOYMENT STATUS

Derived identity, defined as a sense of self that is overly influenced by and dependent upon relationships with significant others, and depressive symptomatology, measured by the CES-D scale, were assessed in a sample of 564 adult women classified into one of six marital-employment status groups: married professional, single professional, married nonprofessional, single nonprofessional, married nonemployed, and single nonemployed. Married women were found to report more derived identity than single women and when age effects were controlled, married women also had higher CES-D scores than single women. Employment status results in aggregate indicated that for women of equal education: (1) employment outside the home, whether it be professional or non-professional, is related to a more autonomous sense of self than nonemployment and (2) employment outside the home is not associated with lower CES-D scores than nonemployment. Derived identity and depression were also found to be significantly correlated within the total sample and within each marital-employment status group.     

Remembering the forgotten: psychotherapy groups for the nursing home resident

The mental health needs of the long-term nursing home resident receive little attention. It is especially difficult for the more cognitively intact resident to obtain psychological help. An integrated group psychotherapy model that incorporates developmental, cognitive-behavioral, and psychodynamic approaches is described, based on the author's clinical experience in developing and co-leading four groups in three long-term care facilities over a period of ten years. The technical and countertransference challenges of working with this unique population and in this format are described, along with clinical material to illustrate common themes. The success of the groups in improving the morale, sense of community, and quality of life for group members is demonstrated.     

Suicidal Intent/Life Satisfaction: Comparing the Life Stories of Older Women

The purpose of this paper is to examine the Maris hypothesis that some people have relevant biographies and life histories that predispose suicidal careers. Using a life history approach, this paper reports differing themes in the lives of two groups of older women recently relocated to a nursing home—those who are satisfied with their lives and those who are not. Twelve women were selected from a sample of 256 by their scores on a life satisfaction index or suicidal intent scale. Seventy-two hours of transcribed life histories were content-analyzed for dominant themes that contributed to either life satisfaction or suicidal intent. Strong overall themes emerged for both groups under the headings of childhood, families, role models, connectedness, confidantes, life involvement, death experience, and memories. However, the most important correlates to contribute to a suicidal career for ideators were dysfunctional families of origin, poor role models, a feeling of isolation, and a pessimistic outlook.     

Interpersonal Conflicts of Women in Nursing Homes: An Administrative Perspective

Older women may respond to conflicts by suppressing anger. Suppressed anger is associated with depression and hypertension. Research on the everyday conflicts of community-dwelling older women has begun to emerge. Such information is not available for women in nursing homes, and is necessary for developing interventions that can help protect women in nursing homes against anger-related illness. Nursing home administrators were surveyed to evaluate women's health promotion programming in general, and the incidence of and institutional response to conflicts of women residents. About 74% of residents were women; yet, women's health promotion programs were rare (offered in 1 out of 25 facilities, or 4%). Ninety percent of administrators identified depression as the most significant women's health problem, but tended to see it as warranting medical rather than programmatic attention. Eighty percent identified strained interpersonal relationships as a significant health problem for women, requiring programmatic attention. In particular, administrators identified the need for programming to help women residents resolve conflicts with roommates and family members. Formal mechanisms for managing conflicts of residents did not exist in sample nursing homes.     

Pro-active positioning of a social robot intervening upon behavioral disturbances of persons with dementia in a smart nursing home

Behavioral disturbances of persons with dementia residing in a nursing home impose a significant burden on other residents and on the care staff. A social robot can provide an adequate technological support tool for the caregivers by approaching a resident that exhibits a behavioral disturbance. In this paper, we focus on how to position the robot in the nursing home, taking into account the profile and location of the residents. We minimize the time between the detection of a behavioral disturbance and the robot having arrived near the resident and starting an interaction scenario. Our algorithm is evaluated using realistic data that was collected during 3 months in two Belgian nursing homes.     

Social interaction patterns of geriatric home and community residents

Thirty elderly nursing home residents and ten community residing older adults were observed in group settings. Their behavior was assessed for dependent personal maintenance, independent personal maintenance, and appropriate and inappropriate behaviors. Responses by staff and peers to these behaviors were classified as positive, negative, or ignore. The frequency of occurrence of these behaviors as well as the relationship of resident to peer or staff behaviors were analyzed. Results indicate that community-residing elders' behaviors differ from nursing home residents' in quantity rather than quality of interactions. There was a lower frequency of behaviors in the nursing home residents. Though older adults respond differentially to various behaviors of other nursing home residents, staff responses were consistent regardless of residents' behavior. These results suggest that geriatric home residents' behavior can be characterized as withdrawn rather than dependent.     

Effectiveness of nursing counseling on coping and depression in women undergoing in vitro fertilization

The purpose of present study was to evaluate the effectiveness of counseling provided by nurses on depression and coping strategies of infertile women undergoing in vitro fertilization (N=67). Of the 84 women who were interviewed, 30 were accepted as a comparison group, and 37 were included in the study group. The study group women were given counseling in addition to routine nursing care services, including group education and individual interviews about treatment and coping strategies. The nurses also provided support by accompanying the women during the invasive procedures. The Beck Depression Inventory and Jalowiec's Coping Strategies Form were used for measurements. All the women were using emotional coping and had moderate depression prior to the study. There was no statistically significant difference between the comparison and study groups before or after the counseling with respect to depression and coping strategies. Parameters to evaluate the efficacy of counseling are discussed.     

Heal the Hurt Child by Hertha Riese

Abstract

The mental health needs of the long–term nursing home resident receive little attention. It is especially difficult for the more cognitively intact resident to obtain psychological help. An integrated group psychotherapy model that incorporates developmental, cognitive–behavioral, and psychodynamic approaches is described, based on the author’s clinical experience in developing and co–leading four groups in three long–term care facilities over a period of ten years. The technical and countertransference challenges of working with this unique population and in this format are described, along with clinical material to illustrate common themes. The success of the groups in improving the morale, sense of community, and quality of life for group members is demonstrated.     

Dependence in the elderly from an interactional point of view: verbal and observational data

Dependence in the elderly was investigated from an interactional point of view. Observations as well as verbal data of the elderly and professional caregivers were considered. Samples consisted of 14 elderly people receiving regular home health care (M = 78.9, SD = 6.3 years) and 16 elderly people receiving regular nursing home care (M = 81.4, SD = 7.5 years). Results showed a strong tendency toward independence in the elderly. Sense of control in the self-care interactions observed was higher in the home health care group than in the group receiving nursing home care. Division of the elderly into subgroups with high, medium, and low perceived self-efficacy showed that the elderly high in self-efficacy were more independent in terms of observed self-care. Causal explanations of the elderly's competence and their nonuse of competence were significantly different between the elderly and staff.     

Functional Analytic Psychotherapy for Nursing Home Residents: A Single-Subject Investigation of Session-by-Session Changes

Nursing home settings contain unique environmental factors that may promote the acquisition and maintenance of problematic interpersonal behaviors. Functional Analytic Psychotherapy (FAP) is a contextually-based behavior therapy that can be used to modify problematic interpersonal behaviors via carefully provided and contingent in-session responses of the therapist to client behaviors. Thus, FAP would appear to be a particularly well-suited intervention approach for nursing home residents. To date, the effects of FAP have not been reported for nursing home residents. The current single case study assessed the effects of FAP on three nursing home residents using a single-subject AB design. The AB design consisted of a 2-weeks baseline phase followed by a 4-week FAP treatment phase. The nursing home residents completed pre-treatment and post-treatment measures of interpersonal relating. Client interpersonal behaviors were also recorded during each session and coded into two categories: Maladaptive in-session behaviors and adaptive in-session behaviors. Using the reliable change index and Swanson’s dsw to evaluate questionnaire outcomes, results indicated that all three participants reported a significant change in interpersonal functioning. Analysis of in-session behavior indicated that there were significant decreases in maladaptive behaviors and an increase in adaptive behaviors for two clients. Finally, observed in-session behavior changes were congruent with self-reported changes in interpersonal behavior. These results indicate that FAP was an effective intervention for these nursing home residents.     

A Death in the Family: Report of a Single-Session Trauma Group for Nursing Home Residents and Staff

This article describes a single-session trauma-debriefing group conducted at a nursing home following the death of a resident on an outing. The group had as its core an existing weekly therapy group in the facility, with the addition of affected staff, family, and other residents who were on the outing. The treatment illustrates four principles relevant to counseling and psychotherapy in nursing homes: 1) recognition of death; 2) treatment in and of the milieu; 3) flexibility and structure; and 4) dealing with countertransference. Along the way, we see how the residents are capable of giving, and not merely receiving.     

Specificity of the 21-Item Test in two elderly samples

ABSTRACT The purpose of this study was to measure the specificity of the 21-Item Test for detecting malingering in an elderly sample. The 21-Item Test was administered to 20 community-dwelling elderly individuals with means for age, education, and Short Portable Mental Status Questionnaire (SPMSQ) error scores of 76.25 years (SD?=?7.19), 14.30 years (SD?=?3.89), and 0.30 (SD?=?4.70). None of these healthy elderly participants were cognitively impaired. A second group of 53 nursing home residents had means for age, education, and SPMSQ error scores of 82.79 years (SD?=?8.56), 11.14 years (SD = 2.46), and 3.17 (SD?=?2.46). Approximately 60% of the nursing home participants had cognitive impairment based on the SPMSQ. The cut offs provided by Iverson (1998 , 21 Item Test Research Manual) for interpretation of the forced-choice component of the 21-Item Test were insensitive to age and relatively insensitive to cognitive deficits. Specificity was 100% since no elderly participant from either group scored in the range indicative of sub-optimal effort or biased responding.     

Depression: Psychological Referrals in Nursing Homes

Studies in nursing homes have consistently shown the presence of mental health disorders. We assessed 300 nursing home residents (referred for psychological testing) to provide preliminary data on referral patterns, assess the cognitive and affective patterns of residents with different diagnoses, and present psychometric data on depression measures, including the Beck Depression Scale (BDI) (as a bivariate index) and the Mood Scale (a shortened version of the Geriatric Depression Scale). Results show that the referrals involved a compromised group of residents, both cognitively and affectively. Despite obvious mean differences, a MANOVA revealed that Major Depressive Disorder did not differ significantly from the Adjustment Disorder and Dementia groups on the bivariate BDI and Mood Scale; the dementia group was lower than the depression and adjustment groups on the MMSE. Patterns on depression inventories also identified a correct classification score of 4 on the BDI (89%) and 3 on the Mood Scale (79%). Discussion endorsed use of the bivariate BDI and addressed depression in these facilities.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Relationships between steps taken in selecting a nursing home and consumers' satisfaction.

Analysis of data related to selection of a nursing home by 411 families of nursing home residents led to the conclusion that steps selected and taken by consumers in the selection of a home were associated with their subsequent satisfaction with the home. Satisfaction was greater (a) for families in agreement about the home selected and (b) for families who investigated all homes in an area before selecting one. Less satisfied were families (a) who were forced to make an immediate decision about placement following illness of a patient, (b) who felt they lacked sufficient time to investigate homes, and (c) who chose the first home with space available.     

Psychoneurotic Art: Its Function in Psychotherapy by Margaret Naumburg

This article describes group psychotherapy with nursing home residents, ages 64-96, which utilizes the nonverbal and symbolic activities of drama therapy to facilitate an orientation to insight and transference phenomena, in contrast to the purely supportive techniques often used with the elderly. A case study of a long-term therapy group is described with examples of how the patients confronted their physical limitations, the death of their parents and of themselves, and transferences to the therapist. The media of creative drama, by concretizing and symbolizing difficult feeling states, and thus encouraging verbalization, may be a useful aid in extending the benefits of expressive psychotherapy to the impaired elderly.     

Experimental pain thresholds influenced by sex of experimenter

Thresholds for pressure pain were tested in 64 adult human subjects (age: M=22.0 yr., SD=7.5). The subjects were young adults drawn from a student population. They were divided into two groups of men and two groups of women, with 16 participants in each group. A female experimenter tested one group of men and a male experimenter tested the other group. The women were tested in a similar way by an experimenter of the same sex for one group and the opposite sex for the other group. The two experimenters were dressed in a manner that emphasised their gender roles. The men tested by a female experimenter showed a higher average pain threshold than the men tested by a male experimenter, but there was no difference in the average pain thresholds of the two groups of women.