Psychogeriatric Outreach To Rural Families: The Iowa and Virginia Models

Abstract

Elderly residents of rural areas are at significant risk for mental health problems, yet have less access to mental health services. Thus, most mental health problems among rural elderly remain either undiagnosed or untreated. We describe two models of mental health outreach programs to rural elderly in Iowa and Virginia, serving demographically, culturally, and epidemiologically different populations in geographically and economically dissimilar regions. Programs are compared on the basis of initiation, community partnerships, target population, target region, clinical disciplines involved, coordinating discipline, referral sources, operational model, initial home assessment, care planning, sustainability, cost, patient demographics, and primary and secondary diagnoses. Outreach programs are argued to be effective models of delivering services to geographically and/or socially isolated elderly populations. The experiences of our programs, though limited to rural populations, may be of relevance to any outreach program attempting to serve elderly presenting with or at risk for mental health problems.

Social networks and health of older people living in sheltered housing

“…In the absence of social support, loneliness and social isolation increase and are associated with risk of mental health problems (Wenger, 1997). For this reason socially isolated older people have been targeted by mental health teams (Abraham et al, 1993).This targeting could be done through wardens being made aware of these risk factors for mental health problems and encouraging them to monitor levels of loneliness and social isolation in residents and to develop their knowledge of their residents' network types and the social support received so that they are aware of the strengths and vulnerabilities of residents and their support networks. Training wardens in dealing with dif cult group dynamics is another potentially useful area of input.…”

Mental health services for rural elderly: Innovative service strategies

“…Others claim that the nature of clinical depression among the elderly makes diagnosis more difficult, and many with symptomatology escape detection in primary care settings (Abraham, Buckwalter, Snustad, Smullen, Thompson-Heisterman, Neese, & Smith, 1993;Buckwalter, Smith, & Caston, 1994). Elderly experience relatively more episodic depression (5.6%) of minor and major types than either 18 to 44 year-olds (4.3%) or 45 to 64 year-olds (2.7%).…”

“…Predominant values and themes of "being in the world" attributed to rural settings include: subjugation of person to nature; individualism; an emphasis on relationships and family ties; traditionalism; historicism; fatalism; a work ethic; conservative beliefs; and strong religious values (Abraham et al, 1993). Many rural elderly belong to at least one additional subculture based upon foreign national origin, race or ethnicity, language, religion, and minority status.…”

Factors Predicting Crisis Counselor Referrals to Other Crisis Counseling, Disaster Relief, and Psychological Services: A Cross-Site Analysis of Post-Katrina Programs

“…This includes exploring crisis counselors' ability to detect client needs, their awareness of community resources, their ability to match client needs to local services, and their role in fostering client acceptance of referrals. Illuminating outreach workers' role in mediating referrals can inform not only crisis counseling, but also mental health outreach programs serving other populations, such as elders (Abraham et al 1993), homeless veterans (Kasprow et al 2000;Lam and Rosenheck 1999;McGuire et al 2003), and individuals with HIV (Naar-King et al 2007). number N00140510629), a Center of Excellence in the Social and…”