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.
Work on this chapter was supported in part by a grant to the senior author from the National Institute on Aging R23 AG05592.
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References
Association for the Advancement of Behavior Therapy. (1977). Ethical issues for human services. New York: Author.
Baltes, M. M., & Zerbe, M. B. (1976). Re-establishment of self-feeding in a nursing home resident. Nursing Research, 25, 24–26.
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.
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.
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.
Berger, R. M., & Rose, S. D. (1977). Interpersonal skill training with institutionalized patients. Journal of Gerontology. 32, 346–353.
Blackman, D., Howe, M., & Pinkston, E. M. (1976). Increasing participation in social interaction of the institutionalized elderly Gerontologist, 16, 69–76.
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.
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.
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.
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.
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.
Carroll, P. S. (1978). The social hour for geropsychiatric patients. Journal of the American Geriatrics Society, 11, 32–35.
Carstensen, L. L. (1986). Social support among the elderly: Limitations of behavioral interventions. The Behavior Therapist, 6, 111–113.
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.
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.
Carstensen, L. L., & Fremouw, W. J. (1981). The demonstration of behavioral intervention for late life paranoia. The Gerontologist, 21, 329–333.
Cornbleth, T. (1977). Effects of protected hospital ward area on wandering and nonwandering geriatric patients. Journal of Gerontology, 32, 573–577.
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.
Eustis, N., Greenberg, J., & Patten, S. (1984). Long-term care for older persons: A policy perspective. Monterey, CA: Brooks/Cole.
Fisher, J. E., & Carstensen, L. L. (1988). The elderly nursing home resident as contingency manager. Unpublished manuscript, University of Indiana, Bloomington.
Geiger, G. O, & Johnson, L. A. (1974). Positive education for elderly persons, correct eating through reinforcement. The Gerontologist, 14, 488–491.
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.
Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. Garden City, NY: Doubleday.
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.
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.
Harel, Z., & Noelker, L. (1983). Social integration, health and choice: The impact of well-being on institutionalized aged. Research on Aging, 4, 97–111.
Hogue, C. C. (1985). Mobility. In E. Schneider (Ed.), The teaching nursing home (pp. 231–243). New York: Raven Press.
Hoyer, W. J. (1973). Application of operant techniques to the modification of elderly behavior. The Gerontologist, 13, 18–22.
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.
Hussian, R. A. (1981). Geriatric psychology: A behavioral perspective. New York: Van Nostrand Reinhold.
Hussian, R. A., & Davis, R. L. (1985). Responsive care: Behavioral interventions with elderly persons. Champaign, IL: Research Press.
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.
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.
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.
Lesnoff-Caravaglia, G. (1978–1979). The five percent fallacy. International Journal of Aging and Human Development, 79, 187–192.
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.
MacDonald, M. L. (1978). Environmental programming for the socially isolated aging. Gerontologist, 18, 350–354.
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.
McCullough, L. B. (1984). Medical care for elderly patients with diminished competence: An ethical analysis. Journal of the American Geriatrics Society, 32, 150–153.
Mueller, D. J., & Atlas, L. (1972). Resocialization of depressed elderly residents: A behavioral management approach. Journal of Gerontology, 27, 390–392.
Murray, H. (1938). Explorations in personality. New York: Oxford University Press.
Newman, S. J. (1976). Housing adjustment of older people: A report from second phase. Ann Arbor: University of Michigan, Institute for Social Research.
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.
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.
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.
Page, S., Caron, P., & Yates, E. (1975). Behavior modification methods and institutional psychology. Professional Psychology, 175–181.
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.
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.
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.
Ratzan, R. M. (1980). ‘Being old makes you different’: The ethics of research with elderly subjects. Hastings Center Report, 10, 32–42.
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.
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.
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.
Sachs, D. A. (1975). Behavioral techniques in a residential nursing home facility. Journal of Behavior Therapy and Experimental Psychiatry, 6, 123–127.
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.
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.
Shanas, E. (1982). National survey of the aged (Office of Human Development Services, DHHS Publication No. OHDS83–20425). Washington, DC.: OHDS.
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.
Sperbeck, D. J., & Whitbourne, S. K. (1981). Dependency in the institutional setting: A behavioral training program for geriatric staff. The Gerontologist, 21, 268–275.
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.
Toseland, R. W. (1977). A comparison of three group methods to train social skills in older persons. The Gerontologist, 17, 127.
U.S. Bureau of Census. (1976). Survey of institutionalized persons. Current population reports (Special Studies Series P-23, No. 69). Washington, DC: Author.
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.
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.
Vladeck, B. C. (1980). Unloving care: The nursing home tragedy. New York: Basic Books.
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.
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.
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.
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.
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Carstensen, L.L., Fisher, J.E. (1991). Treatment Applications for Psychological and Behavioral Problems of the Elderly in Nursing Homes. In: Wisocki, P.A. (eds) Handbook of Clinical Behavior Therapy with the Elderly Client. Applied Clinical Psychology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-0638-0_15
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