Psychological Treatment of Older Adults: A Holistic Model

477 Pages·2013·24.77 MB·English

by  Lee Hyer PhD ABPP

Psychological Treatment of Older Adults H
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A Holistic Model
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Lee Hyer, PhD, ABPP s
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“This is one of the best mental health and aging books I have ever read. [It] is one that I will turn to often in my c
teaching of doctoral students, and in my work with older adults. One of the phenomenal aspects of this book h
is the research reviews, which are in-depth and broad in their scope. It is clear that Lee Hyer is an exceptional o
scholar–clinician and geropsychologist.” —Peter A. lichtenberg, PhD l Psychological
Director, Institute of Gerontology and the o
Merrill Palmer Skillman Institute, Wayne State University g
i
Drawing from current research and clinical practice, this text espouses a unique interdisciplinary c
approach to the assessment and treatment of psychosocial impairment in older adults. This a
approach, called “Watch and Wait,” is grounded in a whole-person model of care rather than one that l Treatment

addresses symptoms or syndromes in isolation. This model advocates relationship building, prevention, T
psychoeducation, multipronged interventions for comorbid problems, and communication. It does so in r
the context of a multidisciplinary health care team, the patient, and family. e
a
The model encompasses five core factors of psychosocial impairment in older adults: depression, anxiety,
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cognitive deficits, adjustment or life problems, and health issues. Considered together, they provide an m of Older Adults
integrated understanding of the older adult that is more likely than single-disorder models to facilitate
successful outcomes for common psychosocial difficulties that occur in later life. The book describes in e
depth the unique components and complex interactive influences of these five factors as they apply to n
older adults seeking mental health treatment. A cornerstone of the author’s approach is treatment based
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on stringent care-based assessment and thorough monitoring of empirically supported interventions. Each
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factor is considered individually from its empirically supported basis as well as its interaction with the
other factors. Distinct treatment modules are isolated for each factor and assembled to provide the optimal f

pathway for clinical treatment. O
A H o l i s t i c M o d e l
The text also addresses the unique difficulties of diagnosing the aging population, the pitfalls of existing l
treatments, and the need for brain-based models for care. d
e
Key FeAtures: r

• Advocates for integrative, interdisciplinary care and primary care involvement for the older adult A
• Emphasizes core components of care: depression, anxiety, cognition, pain/sleep/health issues,
d
adjustment in the community
u
• Demonstrates how a single-problem approach for older adults with psychiatric problems is not effective
or efficient care lt
• Espouses a “Watch and Wait” paradigm of care, based on person-centered diagnosis and careful s
monitoring of treatment
• Translates and integrates current research findings with clarity
• Covers use of SSRIs and other medications, suicide, subsyndromal states, issues involving cost of care
for the older patient, among other topics
• P lentiful case examples
ISBN 978-0-8261-9591-3
11 W. 42nd Street
Lee Hyer
New York, NY 10036-8002 9 780826 195913
www.springerpub.com
Psychological Treatment of Older Adults
Lee Hyer, PhD, ABPP, is professor of psychiatry and health behavior at the
Mercer School of Medicine and the Georgia Neurosurgical Institute. He is board
certified in psychology through the American Board of Professional P sychology
(ABPP). He is a fellow of several divisions of the American Psychological
Association (APA), a member of the International Society of Traumatic Stress,
and the Gerontological Society of America. He has been a professor of psy-
chiatry for many years at the Medical College of Georgia; at the Veterans
Administration (VA); and at the University of Medicine and Dentistry of New
Jersey, Robert Wood Johnson Medical School. He is the recipient of several awards
given by the VA, the Distinguished Researcher Award from Psychologists in
Long-Term Care (2005); and was honored as Mentor of the Year, APA Division
of Clinical Psychology (2007). His professional contributions include more than
200 articles and book chapters, and he has written three books. Dr. Hyer has been
the clinical editor of several journals, as well as a reviewer. He currently is the
recipient of several grants on topics ranging from pain, cognitive training, cogni-
tive assessment, and depression/anxiety, all of which are related to older adults.
Psychological Treatment of Older Adults
A Holistic Model
Lee Hyer, PhD, ABPP
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ISBN: 978-0-8261-9591-3
e-book ISBN: 978-0-8261-9592-0
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Library of Congress Cataloging-in-Publication Data
Hyer, Lee, 1944– author.
Psychological treatment of older adults : A holistic model/Lee Hyer
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8261-9591-3 —ISBN 978-0-8261-9592-0 (e-book)
I. Title.
[DNLM: 1. Aged—psychology. 2. Psychotherapy—methods. 3. Geriatric
Psychiatry—methods. 4. Holistic Health. 5. Mental Disorders—psychology.
6. Mental Disorders—therapy. WT 150]
RC451.4.M54
618.97′8914—dc23
2013020124
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To mentors across the years, nonpareil;
without whom this work would not have been possible.
John Mierzwa (posthumus), Lehigh University
Ted Millon, University of Miami
Merle Tate (posthumus), Lehigh University
Ilene Siegler, Duke University
Dan Blazer, Duke University
Lenny Poon, University of Georgia
William Reichman, Baycrest, University of Toronto
Pat Boudewyns, VAMC Augusta, GA and Medical
College of Georgia
Jeff Brandsma (posthumus), Medical College of Georgia

Contents
Foreword Peter A. Lichtenberg, PhD xi
Preface xv
1. Introduction 1
Process of Care 6
Backdrop 8
Best Predictors 11
Conclusion 28
2. Model of Care 31
Model 33
Case Formulation and the Five Domains of Treatment 38
Watch and Wait Ingredients 41
Perspective 45
Conclusion 49
3. Psychotherapy 51
Lee Hyer and Maria Anastasiades
Problems of Science 52
General Reviews: Data Related to Older Adults 54
Late-Life Psychotherapy Overview 57
Medications 60
Our Position 62
Necessary Psychotherapy Features 65
Core Treatment Factor: Psychoeducation 65
Core Treatment Factor: Alliance 67
Core Treatment Factor: Monitoring 69
Core Treatment Factor: Case-Based Approach 70
Recommended Treatment Factor: Motivational Interviewing 71
Recommended Treatment Factor: Behavioral Activation 74
vii
viii Contents
Recommended Treatment Factor: IPT 74
Recommended Treatment Factor: PST 76
Recommended Treatment Factor: Transdiagnostic Model 76
Recommended Treatment Factor: Prevention 78
Recommended Treatment Factor: Case Manager 80
Recommended Treatment Factor: Exercise 81
Recommended Treatment Factor: Modules 81
Recommended Treatment Factor: Cognitive Training 82
Recommended Treatment Factor: Psychotherapist
as Neuroscientist 84
Recommended Treatment Factor: Booster Sessions 85
Conclusion 87
4. Depression 89
Prevalence and Biology 90
Phenomenology of Depression 91
Correlative Symptoms 98
Treatment Studies 104
Predictors of Depression at Late Life and When to Change 110
Recommended Treatment 111
Special Case of Home Care 121
Conclusion 122
5. Anxiety at Later Life 123
Prevalence 124
Phenomena of Anxiety 125
Anxiety and Cognition 129
Anxiety and the Brain 130
Treatment Studies 131
Medication 133
Modules and Venues and Other Therapies 134
Exercise 136
Treatment Summary 137
Formal Treatment Package 139
Special Case: PTSD 143
Conclusion 146
6. Cognition 147
Normal Aging: What Is Up With Cognition? 150
Continuum of Cognitive Decline 154
MCI 156
Dementia Criteria and Confusion 159
Memory 164
EF Problems (and Depression) 166
Medical Treatment for Dementia 169
Conclusion 174
Contents ix
7. Cognitive Training 175
Cognition Training 176
Overview 178
Holistic Programs 180
Working Memory and Older Adults 181
Cognitive Compromise: MCI or Mild Dementia 182
Conclusion 196
8. Health Issues 197
Integrated Care 199
Too Many Best Care Practices 199
Mental Health 202
Core Problems 205
Conclusion 230
9. Medical Problems 231
Richard Ackermann
Principles of Geriatric Health Care 231
Conclusion 247
10. B ehavioral Health Treatment of Older Adults
in Primary Care 249
Catherine Yeager
The Development of the Patient-Centered Medical Home 251
Role and Expertise of the Primary Care Psychologist 254
Common Behavioral Health Interventions in Primary Care 265
Common Presenting Problems in Primary Care 272
Conclusion 281
Notes 282
11. Life Issues 283
Lee Hyer, Maria Anastasiades, and Sanna Catherine Tillitski
Old-Age Perspective 285
Evaluation: Point of Care and Long View 287
Different Prisms of Treatment 288
Practical Issues for Community Care 293
Long-Term Care 307
Conclusion 310
12. Assessment 313
Lee Hyer and Sanna Catherine Tillitski
The Whole Person 316
Cognition 318
Function: Think Outside the Box 324
Depression 328
Anxiety 330