Clinical Mental Health Outreach to Older Adults: Serving the Hard-to-Serve

Yang, Janet Anderson; Garis, Jamie; McClure, Regina

doi:10.1300/j018v29n02_08

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Staff training and skills have been considered in some studies, although there does not appear to have been any evaluation of skills development or of training packages or workforce models. Concurring with the conclusions of other studies, 81,86,87 Rogoz et al 70 suggested that improved access and delivery of services to homeless older people with memory problems should be undertaken by specialist, multidisciplinary teams of health professionals. The skills reportedly needed were summarised as spanning the areas of outreach, assessment and multimorbidity management.…”

Section: Servicesmentioning

confidence: 87%

Service provision for older homeless people with memory problems: a mixed-methods study

Manthorpe

Samsi

Joly

et al. 2019

Health Serv Deliv Res

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Background Early or timely recognition of dementia is a key policy goal of the National Dementia Strategy. However, older people who are homeless are not considered in this policy and practice imperative, despite their high risk of developing dementia. Objectives and study design This 24-month study was designed to (1) determine the prevalence of memory problems among hostel-dwelling homeless older people and the extent to which staff are aware of these problems; (2) identify help and support received, current care and support pathways; (3) explore quality of life among older homeless people with memory problems; (4) investigate service costs for older homeless people with memory problems, compared with services costs for those without; and (5) identify unmet needs or gaps in services. Participants Following two literature reviews to help study development, we recruited eight hostels – four in London and four in North England. From these, we first interviewed 62 older homeless people, exploring current health, lifestyle and memory. Memory assessment was also conducted with these participants. Of these participants, 47 were included in the case study groups – 23 had ‘memory problems’, 17 had ‘no memory problems’ and 7 were ‘borderline’. We interviewed 43 hostel staff who were participants’ key workers. We went back 3 and 6 months later to ask further about residents’ support, service costs and any unmet needs. Findings Overall, the general system of memory assessment for this group was found to be difficult to access and not patient-centred. Older people living in hostels are likely to have several long-term conditions including mental health needs, which remain largely unacknowledged. Participants frequently reported experiences of declining abilities and hostel staff were often undertaking substantial care for residents. Limitations The hostels that were accessed were mainly in urban areas, and the needs of homeless people in rural areas were not specifically captured. For many residents, we were unable to access NHS data. Many hostel staff referred to this study as ‘dementia’ focused when introducing it to residents, which may have deterred recruitment. Conclusions To the best of our knowledge, no other study and no policy acknowledges hostels as ‘dementia communities’ or questions the appropriateness of hostel accommodation for people with dementia. Given the declining number of hostels in England, the limits of NHS engagement with this sector and growing homelessness, this group of people with dementia are under-recognised and excluded from other initiatives. Future work A longitudinal study could follow hostel dwellers and outcomes. Ways of improving clinical assessment, record-keeping and treatment could be investigated. A dementia diagnosis could trigger sustained care co-ordination for this vulnerable group. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Servicesmentioning

confidence: 87%

Service provision for older homeless people with memory problems: a mixed-methods study

Manthorpe

Samsi

Joly

et al. 2019

Health Serv Deliv Res

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“…While Mr. T. showed evidence of delusions, he functioned fairly well otherwise. At the age of 83, he lived alone, taking care of his daily needs. Heritage Clinic’s treatment approach includes the following stages: outreach, engagement, consent, case management, and relational psychotherapy (Yang, Garis, & McClure, 2006).…”

Section: Treatment Of Older Adults With Delusional Disordermentioning

confidence: 99%

Psychotherapeutic Treatment of Psychotic Disorders in Later Life

Yang¹,

Garis²,

Lowe³

2015

GeroPsych

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Older adults exhibit psychotic symptoms for various reasons. Treatment may require medical and psychiatric intervention, family support, community services, etc. The role of psychotherapy, however, has received little attention. This article describes a psychotherapeutic approach to treating older adults with psychotic symptoms based on the literature and the authors’ own experience. The approach includes reaching out to identify individuals in need of help; clinical engagement to develop a working relationship; linkage with needed services; and helping individuals reduce the link between triggers and psychotic symptoms. Differences between treating a person with delusional disorder versus schizophrenia are discussed.

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“…This can include helping elders utilize available resources to end an abusive relationship or act to enhance their own health and well-being. Effective tools to evoke change and nuanced measures to assess change are particularly important for jeopardized elders, as interventions often show small effects over an extended period of time (Yang, Garis, & McClure, 2005). With an approach based on relationship building and practical intervention, the current program utilized a pragmatic and nonjudgmental approach to reducing risk factors by matching interventions with elders' preferences and needs.…”

Section: Abstract Elder Abuse Intervention Risk Factors For Abuse Smentioning

confidence: 99%

Eliciting Change in At-Risk Elders (ECARE): Evaluation of an Elder Abuse Intervention Program

Mariam¹,

McClure²,

Robinson³

et al. 2014

Journal of Elder Abuse & Neglect

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The current study evaluated the effectiveness of a community-based elder abuse intervention program that assists suspected victims of elder abuse and self-neglect through a partnership with local law enforcement. This program, Eliciting Change in At-Risk Elders, involves building alliances with the elder and family members, connecting the elder to supportive services that reduce risk of further abuse, and utilizing motivational interviewing-type skills to help elders overcome ambivalence regarding making difficult life changes. Risk factors of elder abuse decreased over the course of the intervention and nearly three-quarters of participants made progress on their treatment goal, advancing at least one of Prochaska and DiClemente's (1983) stages of change (precontemplation, contemplation, preparation, action, and maintenance). Forty-three percent of elders moved into the stages of action and maintenance regarding their goal. The usefulness of eliciting change via longer-term relationships with vulnerable elders in entrenched elder abuse situations is discussed.

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Clinical Mental Health Outreach to Older Adults: Serving the Hard-to-Serve

Cited by 7 publications

References 8 publications

Service provision for older homeless people with memory problems: a mixed-methods study

Service provision for older homeless people with memory problems: a mixed-methods study

Psychotherapeutic Treatment of Psychotic Disorders in Later Life

Eliciting Change in At-Risk Elders (ECARE): Evaluation of an Elder Abuse Intervention Program

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