Treatment Applications for Psychological and Behavioral Problems of the Elderly in Nursing Homes

  • Laura L. Carstensen
  • Jane E. Fisher
Part of the Applied Clinical Psychology book series (NSSB)

Abstract

About 1.3 million elderly people currently live in some 18, 000 nursing homes in this country (Eustis, Greenberg, & Patten, 1984). Although this number represents only 5% of the population of elderly persons, it is misleading to think that nursing home placement is a concern for an insignificant portion of the aged population. Only 5% reside in nursing homes at any point in time, but the lifetime probability of placement in a nursing home is 25–30% (Lesnoff-Caravaglia, 1978–1979). That is, for those elderly who live into advanced old age, the odds of placement increase from 1 in 20 to 1 in 4. As the aging population steadily grows in size, with the “old-old” segment growing fastest, the absolute number of old people living in nursing homes will continue to increase well past the turn of the century. By 2050, if present trends continue, the number of institutionalized elderly people is expected to reach 5.2 million (Brody & Foley, 1985). There is no doubt that this group of physically frail elderly, has psychological problems that demand our attention, problems that present significant economic, social, and ethical dilemmas for families, caregivers, and professionals involved in their care.

Keywords

Nursing Home Stimulus Control Nursing Home Resident Apply Behavior Analysis Paranoid Ideation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Association for the Advancement of Behavior Therapy. (1977). Ethical issues for human services. New York: Author.Google Scholar
  2. Baltes, M. M., & Zerbe, M. B. (1976). Re-establishment of self-feeding in a nursing home resident. Nursing Research, 25, 24–26.PubMedCrossRefGoogle Scholar
  3. Baltes, M. M., Burgess, R. L., & Stewart, R. B. (1980). Independence and dependence in nursing home residents: An operant ecological study. International Journal of Behavioral Development, 3, 489–500.CrossRefGoogle Scholar
  4. Baltes, M. M., Honn, S., Barton, E. M., Orzech, M., & Lago, D. (1983). On the social ecology of dependence and independence in elderly nursing home residents: A replication and extension. Journal of Gerontology, 38, 556–564.PubMedCrossRefGoogle Scholar
  5. Barton, E. M., Baltes, M. M., & Orzech, M. J. (1980). On the etiology of dependence in older nursing home residents during morning care: The role of staff behavior. Journal of Personality and Social Psychology, 38, 423–431.PubMedCrossRefGoogle Scholar
  6. Berger, R. M., & Rose, S. D. (1977). Interpersonal skill training with institutionalized patients. Journal of Gerontology. 32, 346–353.PubMedCrossRefGoogle Scholar
  7. Blackman, D., Howe, M., & Pinkston, E. M. (1976). Increasing participation in social interaction of the institutionalized elderly Gerontologist, 16, 69–76.PubMedCrossRefGoogle Scholar
  8. Blazer, D. G. (1980). The epidemiology of mental illness in late life. In E. W. Busse & D. G. Blazer (Eds.), Handbook of geriatric psychiatry (pp. 3–27). New York: Van Nostrand Reinhold.Google Scholar
  9. Brody, E. M. (1986). The role of the family in nursing homes: Implications for research and public policy. In N. Harper (Ed.), Mental illness in nursing homes: Agenda for research (pp. 159–179). Washington, DC: National Institute of Mental Health.Google Scholar
  10. Brody, J. A., & Foley, D. J. (1985). Epidemiologic considerations. In E. L. Schneider (Ed.), The teaching nursing home (pp. 9–25). New York: Raven Press.Google Scholar
  11. Brody, S. J., Poulshock, S. W., & Masciocchi, C. F. (1978). The family caring unit: A major consideration in the long-term support system. The Gerontologist, 18, 556–561.PubMedCrossRefGoogle Scholar
  12. Burgio, L. D., Burgio, K. L., Engel, B. T., & Tice, L. M. (1986). Increasing distance and independence of ambulation in elderly nursing home residents. Journal of Applied Behavior Analysis, 19, 357–366.PubMedCrossRefGoogle Scholar
  13. Carroll, P. S. (1978). The social hour for geropsychiatric patients. Journal of the American Geriatrics Society, 11, 32–35.Google Scholar
  14. Carstensen, L. L. (1986). Social support among the elderly: Limitations of behavioral interventions. The Behavior Therapist, 6, 111–113.Google Scholar
  15. Carstensen, L. L., & Erikson, R. J. (1986). Increasing rates of social interactions among nursing home residents: Are high rates enough? Journal of Applied Behavioral Analysis, 19, 349–355.CrossRefGoogle Scholar
  16. Carstensen, L. L., & Fisher, J. E. (1984). Mental health needs of the elderly in nursing homes: Staff and resident perspectives. Paper presented at the Association for the Advancement of Behavior Therapy, Philadelphia.Google Scholar
  17. Carstensen, L. L., & Fremouw, W. J. (1981). The demonstration of behavioral intervention for late life paranoia. The Gerontologist, 21, 329–333.PubMedCrossRefGoogle Scholar
  18. Cornbleth, T. (1977). Effects of protected hospital ward area on wandering and nonwandering geriatric patients. Journal of Gerontology, 32, 573–577.PubMedCrossRefGoogle Scholar
  19. Eisdorfer, C. (1980). Paranoia and schizophrenic disorders in late life. In E. W. Busse & D. G. Blazer (Eds.), Handbook of geriatric psychiatry (pp. 329–337). New York: Van Nostrand Reinhold.Google Scholar
  20. Eustis, N., Greenberg, J., & Patten, S. (1984). Long-term care for older persons: A policy perspective. Monterey, CA: Brooks/Cole.Google Scholar
  21. Fisher, J. E., & Carstensen, L. L. (1988). The elderly nursing home resident as contingency manager. Unpublished manuscript, University of Indiana, Bloomington.Google Scholar
  22. Geiger, G. O, & Johnson, L. A. (1974). Positive education for elderly persons, correct eating through reinforcement. The Gerontologist, 14, 488–491.CrossRefGoogle Scholar
  23. Glasscote, R. M. (1976). Old-folks at home: A field of nursing and board-and-care homes. Washington, DC: American Psychiatric Association and the National Association for Mental Health, Joint Information Service.Google Scholar
  24. Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. Garden City, NY: Doubleday.Google Scholar
  25. Goldfried, M. R., & D’Zurilla, T. J. (1969). A behavioral-analytic model for assessing competence. In C. D. Spielberger (Ed.), current topics in clinical and community psychology (Vol. 1, pp. 151–196). New York: Academic Press.Google Scholar
  26. Goldstein, A. P., Sprafkin, R. P., & Gershaw, N. J. (1976). Structured learning therapy-training for community living. Psychotherapy: Theory, Research, and Practice, 13, 374–377.CrossRefGoogle Scholar
  27. Harel, Z., & Noelker, L. (1983). Social integration, health and choice: The impact of well-being on institutionalized aged. Research on Aging, 4, 97–111.CrossRefGoogle Scholar
  28. Hogue, C. C. (1985). Mobility. In E. Schneider (Ed.), The teaching nursing home (pp. 231–243). New York: Raven Press.Google Scholar
  29. Hoyer, W. J. (1973). Application of operant techniques to the modification of elderly behavior. The Gerontologist, 13, 18–22.CrossRefGoogle Scholar
  30. Hoyer, W. J., Kafer, R. J., Simpson, S. C., & Hoyer, F. W. (1974). Reinforcement of verbal behavior in elderly mental patients using operant procedures. The Gerontologist, 14, 149–152.PubMedCrossRefGoogle Scholar
  31. Hussian, R. A. (1981). Geriatric psychology: A behavioral perspective. New York: Van Nostrand Reinhold.Google Scholar
  32. Hussian, R. A., & Davis, R. L. (1985). Responsive care: Behavioral interventions with elderly persons. Champaign, IL: Research Press.Google Scholar
  33. Lawton, M. P. (1975). Competence, environmental press and the adaptation of older people. In P. G. Windley & G. Ernst (Eds.), Theory development in environment and aging (pp. 13–70). Washington, DC: Gerontological Society of America.Google Scholar
  34. Lawton, M. P. (1977). The impact of the environment on aging and behavior. In J. E. Birren & W. W. Schaie (Eds.), Handbook of the psychology of aging (pp. 276–301). New York: Van Nostrand Reinhold.Google Scholar
  35. Lawton, M. P., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. P. Lawton (Eds.), The psychology of adult development and aging (pp. 619–674). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  36. Lesnoff-Caravaglia, G. (1978–1979). The five percent fallacy. International Journal of Aging and Human Development, 79, 187–192.Google Scholar
  37. Lopez, M. A. (1980). Social-skills training with institutionalized elderly: Effects of pre-counseling structuring and over-learning on skill acquisitions and transfer. Journal of Counseling Psychology, 27, 286–293.CrossRefGoogle Scholar
  38. MacDonald, M. L. (1978). Environmental programming for the socially isolated aging. Gerontologist, 18, 350–354.PubMedCrossRefGoogle Scholar
  39. MacDonald, M. L., & Butler, A. K. (1974). Reversal of helplessness: Producing walking behavior in nursing home wheelchair residents using behavior modification procedures. Journal of Gerontology, 29, 97–101.PubMedCrossRefGoogle Scholar
  40. McCullough, L. B. (1984). Medical care for elderly patients with diminished competence: An ethical analysis. Journal of the American Geriatrics Society, 32, 150–153.PubMedGoogle Scholar
  41. Mueller, D. J., & Atlas, L. (1972). Resocialization of depressed elderly residents: A behavioral management approach. Journal of Gerontology, 27, 390–392.PubMedCrossRefGoogle Scholar
  42. Murray, H. (1938). Explorations in personality. New York: Oxford University Press.Google Scholar
  43. Newman, S. J. (1976). Housing adjustment of older people: A report from second phase. Ann Arbor: University of Michigan, Institute for Social Research.Google Scholar
  44. O’Brien, F., Bugle, C., & Azrin, N. H. (1972). Training and maintaining a retarded child’s proper eating. Journal of Applied Behavior Analysis, 5, 67–72.PubMedCrossRefGoogle Scholar
  45. O’Donohue, W. T., Fisher, J. E., & Krasner, L. (1986). Behavior therapy and the elderly: A conceptual and ethical analysis. International Journal of Aging and Human Development, 23, 1–15.PubMedCrossRefGoogle Scholar
  46. O’Donohue, W. T., Fisher, J. E., & Krasner, L. (1988). Ethics and the elderly. In L. L. Carstensen & B. A. Edelstein (Eds.), Handbook of clinical gerontology (pp. 387–399). New York: Pergamon Press.Google Scholar
  47. Page, S., Caron, P., & Yates, E. (1975). Behavior modification methods and institutional psychology. Professional Psychology, 175–181.Google Scholar
  48. Pfeiffer, E. (1977). Psychopathology and social pathology. In J. E. Birren & W. K. Schaie (Eds.), Handbook of the psychology of aging (pp. 650–671). New York: Van Nostrand Reinhold.Google Scholar
  49. Pfeiffer, E. (1980). The psychosocial evaluation of the elderly patient. In E. W. Busse & D. G. Blazer (Eds.), Handbook of geriatric psychiatry (pp. 275–284). New York: Van Nostrand Reinhold.Google Scholar
  50. Quattrochi-Tubin, S. & Jason, L. A. (1980). Enhancing social interactions and activity among the elderly through stimulus control. Journal of Applied Behavior Analysis, 13, 159–169.PubMedCrossRefGoogle Scholar
  51. Ratzan, R. M. (1980). ‘Being old makes you different’: The ethics of research with elderly subjects. Hastings Center Report, 10, 32–42.PubMedGoogle Scholar
  52. Richards, W. S., & Thorpe, G. L. (1977). Behavioral approaches to the problems of later life. In M. Storandt, I. C. Siegler, & M. F. Elias (Eds.), The clinical psychology of aging (pp. 253–269). New York: Plenum.Google Scholar
  53. Rinke, C. L., Williams, J. J., Lloyd, K. L., & Smith-Scott, W. (1978). The effects of prompting and reinforcement on self-bathing by elderly residents of nursing homes. Behavior Therapy, 9, 873–881.CrossRefGoogle Scholar
  54. Risely, T. R., & Edwards, K. A. (1978). Behavioral technology for nursing home care: Toward a system of nursing home organization and management. Paper presented at the Nova Behavioral Conference on Aging, Port St. Lucie, FL.Google Scholar
  55. Sachs, D. A. (1975). Behavioral techniques in a residential nursing home facility. Journal of Behavior Therapy and Experimental Psychiatry, 6, 123–127.CrossRefGoogle Scholar
  56. Schmidt, L. J., Reinhardt, A. M., Kane, A. L., & Olsen, D. M. (1977). The mentally ill in nursing homes. Archives of General Psychiatry, 34, 687–691.PubMedCrossRefGoogle Scholar
  57. Shadish, W. R., Straw, R. B., McSweeny, A. J., Koller, D. L., & Bootzin, R. R. (1981). Nursing home care for mental patients: Descriptive data and some propositions. American Journal of Community Psychology, 9, 617–633.PubMedCrossRefGoogle Scholar
  58. Shanas, E. (1982). National survey of the aged (Office of Human Development Services, DHHS Publication No. OHDS83–20425). Washington, DC.: OHDS.Google Scholar
  59. Smith, K. F., & Bengston, V. L. (1979). Positive consequences of institutionalization: Solidarity between elderly parents and their middle-aged children. The Gerontologist, 19, 438–447.PubMedCrossRefGoogle Scholar
  60. Sperbeck, D. J., & Whitbourne, S. K. (1981). Dependency in the institutional setting: A behavioral training program for geriatric staff. The Gerontologist, 21, 268–275.PubMedCrossRefGoogle Scholar
  61. Teeter, R. B., Garet, F. K., Miller, W. B., & Heiland, W. F. (1976). Psychiatric disturbances of aged in skilled nursing homes. American Journal of Psychiatry, 133, 1430–1434.PubMedGoogle Scholar
  62. Toseland, R. W. (1977). A comparison of three group methods to train social skills in older persons. The Gerontologist, 17, 127.CrossRefGoogle Scholar
  63. U.S. Bureau of Census. (1976). Survey of institutionalized persons. Current population reports (Special Studies Series P-23, No. 69). Washington, DC: Author.Google Scholar
  64. U.S. Department of Health, Education and Welfare. (1971). First special report to U.S. Congress on alcohol and health (pp. 23–26). Rockville, MD: National Institute of Alcohol Abuse and Alcoholism.Google Scholar
  65. Vestal, R. E. (1985). Clinical pharmacology. In R. Andes, E. Bierman, & W. Hazzard (Eds.), Principles of geriatric medicine (pp. 424–443). New York: McGraw-Hill.Google Scholar
  66. Vladeck, B. C. (1980). Unloving care: The nursing home tragedy. New York: Basic Books.Google Scholar
  67. Walker, J. L., & Brodie, K. H. (1980). Neuropharmacology of aging. In E. W. Busse & D. G. Blazer (Eds.), Handbook of geriatric psychiatry (pp. 102–134). New York: Van Nostrand Reinhold.Google Scholar
  68. Whanger, A. D. (1980). Treatment within the institutions. In E. W. Busse & D. G. Blazer (Eds.), Handbook of geriatric psychiatry (pp. 102–134). New York: Van Nostrand Reinhold.Google Scholar
  69. Whitman, T. L., Scibak, J. W., & Reid, D. H. (1983). Behavior modification with the severely and profoundly retarded: Research and applications. New York: Academic Press.Google Scholar
  70. Wisocki, P. A., & Mosher, P. M. (1980). Peer-facilitated sign language training for a geriatric stroke victim with chronic brain damage. Journal of Geriatric Psychiatry, 13, 89–102.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Laura L. Carstensen
    • 1
  • Jane E. Fisher
    • 2
  1. 1.Department of PsychologyStanford UniversityStanfordUSA
  2. 2.Department of PsychologyNorthern Illinois UniversityDeKalbUSA

Personalised recommendations