Overcoming Deficits of Aging: A Behavioral Approach PDF
Preview Overcoming Deficits of Aging: A Behavioral Approach
Overcotning Deficits of Aging A BEHA VIORAL APPROACH APPLIED CLINICAL PSYCHOLOGY Series Editors: Alan S. BeHack, Medical College o[ Pennsylvania at EPPI, Philadelphia, Pennsylvania, and Michel Hersen, University o[ Pittsburgh, Pittsburgh, Pennsylvania PARTIAL HOSPIT ALIZATION: A Current Perspedive Edited by Raymond F. Luber HANDBOOK OF MARlT AL THERAPY: A Positive Approach to Helping Troubled Relationships Robert P. Liberman, Eugenie G. Wheeler, Louis A.].M. DeVisser, Julie Kuehnel, and Timothy Kuehnel PERFECTING SOCIAL SKILLS: A Guide to Interpersonal Behavior Development Richard M. Eisler and Lee W. Frederiksen HANDBOOK OF BEHAVIOR MODIFICA TION WITH THE MENT ALL Y RETARDED Edited by Johnny L. Matson and John R. McCartney THE UTILIZATION OF CLASSROOM PEERS AS BEHAVIOR CHANGE AGENTS Edited by Phillip S. Strain FUTURE PERSPECTIVES IN BEHA VIOR THERAPY Edited by Larry Michelson, Michel Hersen, and Samuel M. Turner CLINICAL BEHA VIOR THERAPY WITH CHILOREN Thomas OHendick and Jerome A. Cerny OVERCOMING DEFICITS OF AGING: A Behavioral Approach Roger L. Patterson A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Overcoming Deficits of Aging A BE HA VIORAL APPROACH ROGER L. PA TIERSON Director, Gerontology Program Florida Mental Health Institute Universi/y of South Florida Ta mpa, Florida with LARRY W. DUPREE, DAVID A. EBERL Y, GARY M. JACKSON, and MICHAEL J. O'SULLIVAN Gerontology Program, Florida Mental Health Institute Universi/y of South Florida, Tampa, Florida LOUIS A. PENNER Deparlment of Psychology, Universi/y of South Florida Tampa, Florida and CARLA DEE KELL Y Institute {or Health Maintenance, Tampa, Florida PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Patterson, Roger L. Overcoming deficits of aging. (Applied dinical psychology) Bibliography: p. Indudes index. 1. Aged-Mental health services. 2. Behavior therapy. I. Title. II. Series. [DNLM: 1. Behavior therapy-In old age. WT 150 P31801 RC451.4.A5P35 1982 618.97'689142 82-18076 ISBN-13: 978-1-4615-9265-5 e-ISBN-13: 978-1-4615-9263-1 001: 10.1007/978-1-4615-9263-1 ©1982 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1982 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical. photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Foreword That older patients can be successfully treated has only recently been recognized by professionals and by older persons themselves. That older persons can also be taught new skills or retaught previously existing skills constitutes even newer knowledge. By focusing on the reversibility 0/ behavioral defidts in the elderly the authors, under the leadership of Dr. Roger Patterson, have made both a scientific and a humanitarian contribution to the well-being of older persons. In this volume they have presented a theoretical basis and a practical how-to method of overcoming behavioral deficits. They have demonstrated that their modular technique of fostering improved functioning in such areas as activities of daily living and sodal skills not only has been successful but also has allowed individuals to return to less restrictive environments or to completely independent living. The approach is an interdisciplinary one, appropriately since older people often experience diffirulties in multiple areas of function- ing. The authors have tried to integrate social, medical, and behav- ioral approaches, with an emphasis on behavioral methodologies. Although this book deals primarily with behavioral approaches to treatment of the elderly in a single setting, the volume c1early con- stitutes achallenge to other scientists and clinicians to apply the techniques described here in other settings. A medical colleague of mine, a geriatrician, recently expressed the opinion that he had never encountered an older patient for whom he could not do something to improve health. What Patterson and his colleagues are saying in this book is something very similar, along behavioral lines. They are saying that behavioral deficits in aging are subject to modification, with surprising and gratifying results. Both of these views are new and refreshing. As a gerontologist interested in improving both physical and mental well-being, I heartily concur. v vi FOREWORD Now such views and the attendant requisite skills must be widely disseminated among professionals working with the aging. ERle PFEIFFER, M.D. Suncoast Gerontology Center University of South Florida Tampa, Florida Preface This book is areport of an unusual experience. In November 1975 Roger Patterson was given responsibility for developing a treatment prog ram for elderly people using behavioral methods assembled in a modular fashion. The general idea for such an approach had been proposed by Henry Bates (1975), who developed the idea from an extensive review of the literature. Dr. Patterson directed this effort from its beginning as a basic concept throughout its development and implementation, and continues to direct the operation. This program was to be directed to retuming chronic hospitalized patients to com- munity living and was to be developed into a full-fledged treatment program and evaluated for effectiveness of the treatment. Further- more, it was to serve as a model for dissemination throughout the state of Florida. No part of the program was in existence: staff, c1ients, program, and treatment evaluation all had to be assembled and developed. The opportunity for evaluation of the treatment was unusual in that it was possible to look at three aspects: (1) treatment effects produced by each treatment module, (2) overall behavioral changes produced in the clients during treatment, and (3) what hap- pened to the clients after discharge. Many studies look at one or two of these aspects, but few deal with all three. In order to complete this effort, the work of many individuals was required. Michael O'Sullivan joined the effort very early and handled most of the day-to-day administration of the treatment units in addition to helping develop several modules. For example, the existence of Self- esteem training is largely due to his efforts. Louis Penner joined the effort in its second year as an evaluation consultant and remained affiliated formally or informally through the completion of this book. Carla . Dee Kelly was recruited as a clinical psychologist to lead the staff in the development of individual psychological treatment plans and did much work to improve the functioning of the treatment team. vii viü PREFACE David Eberly had the responsibility of creating a data system, manag- ing ongoing evaluation efforts, and designing and managing training programs in the dissemination efforts. After much of the modular program was developed, Gary Jackson introduced a new system of developing and implementing individual behavioral treatments, pro- vided the staff with excellent training in behavioral methodology, and did much to improve the management of both the residential and day treatment components of the program. Larry Dupree joined the pro- gram to improve our integration with the community and was later put in charge of the day treatment project for the purpose of develop- ing it into a true community project. One may see that these individuals who worked to put an idea into practice each made a unique and valuable contribution. It is for this reason that each of them is an author of this total book and also has additional credits on certain chapters. Individuals with special responsibilities in a certain area took major responsibility for prepar- ing the corresponding chapters, but no segment of the program or book chapter stands alone. Each of the authors is in some way responsible for completion of the whole. In addition to the authors, many other individuals contributed greatly to the development and daily functioning of the program. Manuel Garcia Alvarez was the physician with the program who not only provided excellent medical care to the residential dients but was supportive of staff efforts to develop the behavioral program. Richard Gordon was Director of the Florida Mental Health Institute during the implementation phase of this program and offered encouragement and administrative support. Gail Smith, Tamara Harrell, Constance Miller, JoAnn Vogel, Dana Kessler, and Peggy Goodale had major supervisory and creative roles in many aspects of the program. Jack Anderson organized the data, conducted analyses, and prepared the illustrations for this book. Joan Piroch wrote or edited most of the training manuals for the modules, and these were used in preparing the module descriptions in Chapter 4. Ms. Piroch also edited much of this book. The final production of this book was made possible by the secretarial efforts of Betty Alfonso, Lillian Barry, and Audrey Weislo. Ultimately, the whole work was possible only because of the efforts of very high-quality care staff, to whom gratitude is expressed. Contents Foreword v ERIC PFEIFFER Preface vü 1. The Setting and the Clients 1 MICHAEL J. O'SULLIVAN AND ROGER L. PATIERSON 2. Problems Relating to Aging: Rationale for a Behavioral Approach 7 LARRY W. DuPREE, MICHAEL J. O'SULLIVAN, AND ROGER L. PATIERSON 3. Behavioral Principles and Techniques 23 GARY M. JACKSON AND ROGER L. PATIERSON 4. The Modular Approach to Behavior Modification with the Elderly 53 ROGER L. PATIERSON AND DAVID A. EBERLY 5. Single Cas e Behavioral Treatment 89 GARY M. JACKSON AND ROGER L. PATIERSON 6. The Treatment Team 111 CARLA DEE KELLY AND ROGER L. PATIERSON 7. The Gerontology Evaluation System 143 DAVID A. EBERLY, loUIS A. PENNER, AND ROGER L. PATIERSON ix x CONTENTS 8. Client and Program Characteristics 175 DAVID A. EBERLY AND LOUIS A. PENNER 9. The Evaluation of Program Components 197 LOUIS A. PENNER, DAVID A. EBERLY, AND ROGER L. PATIERSON 10. The Evaluation of the Program 237 loUIS A. PENNER, DAVID A. EBERLY, AND ROGER L. PATIERSON References 279 Index 287
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