February 26, 1975
Page 4442
PSYCHIATRY PAYS MORE ATTENTION TO THE ELDERLY
Mr. MUSKIE. Mr. President, as chairman of the Subcommittee on Health of the Elderly of the Special Committee on Aging, I have been concerned for some time about a general unawareness of mental health needs of older Americans.
The committee, in a November 1971 report, declared:
Widespread confusion and contradictions in public health policy on mental health care of the elderly are causing heavy economic, social, and psychological costs among older Americans and their offspring.
That report, "Mental Health Care and the Elderly: Shortcomings in Public Policy," expressed special concern about: limited attention given to older persons at community health centers, so-called dumping of elderly patients from State hospitals into inappropriate and often wretched quarters, and a general lack of understanding about mental health problems related to aging.
Soon after that report was issued, I introduced legislation calling for a Presidential Commission on Mental Illness and the Elderly American, as recommended by the report and by leading professional organizations related to psychiatry and psychology.
That legislation was passed in modified form last year as part of a bill later vetoed. I intend to seek early action in 1975 on that legislation.
A recent issue of the National Observer carried an important article: "Psychiatrists Pay New Heed to Mental Problems of Aged." I found this article to be very informative about shortsighted attitudes which cling stubbornly in many people's minds. One such attitude existed in the minds of psychiatrists themselves; they seemed to discount the needs of older persons. Some apparently believed that mental illness in the elderly is not reversible. The tragic consequences of such attitudes can be seen in many institutions, where older patients may be regarded as "senile" and therefore beyond help. And yet, it has been demonstrated again and again that the right treatment – sometimes it is merely a change in dietary habits – can lead to dramatic change in the patient's condition.
I believe that the article is timely and useful. I ask unanimous consent to have it printed in the RECORD.
There being no objection, the article was ordered to be printed in the RECORD, as follows:
PSYCHIATRISTS PAY NEW HEED TO MENTAL PROBLEMS OF AGED
(By Dwight Buell)
Sigmund Freud, the founder of psychoanalysis, said patients older than 50 generally couldn't be analyzed and treated successfully because they were too set in their ways. So for years American psychiatrists saw few elderly patients at all.
Now this is changing. As the aged population swells, more psychiatrists are taking an interest in gerontology and in ways of helping the elderly cope with the psychological stresses of aging. Moreover, psychiatrists are discovering, to the surprise of some, that most elderly people are emotionally healthy and that whatever mental disorders they do suffer are often reversible.
These and other unexpected findings about psychiatry for the elderly stem largely from the efforts of the 14-year-old Boston Society for Gerontologic Psychiatry. With an international membership of 150 psychiatrists, psychologists, social workers, clergymen, and other professionals, the organization has produced a wealth of scholarly research in three books and in its Journal of Geriatric Psychiatry.
FEW REALLY HELPLESS
Many of its members devote part of their private practices to elderly patients, even holding therapeutic sessions in the homes of the elderly or visiting them on their deathbeds.
"The usual image of an old person as being sick and helpless is highly misleading," says Dr. Martin A. Berezin, an associate clinical professor of psychiatry at Harvard Medical School and a founder of the society. He estimates that less than 5 per cent require custodial care.
COPING WITH AGING
"Most of the elderly are emotionally healthy people who retain the same life-style, drives, and coping mechanisms as in their younger days, although perhaps with some diminution of degree," adds Berezin, who is 61.
"An elderly person will only be rigid if he was rigid when he was younger. A person who had a calm and happy disposition in his younger days is likely to respond to old age in the same frame of mind. As long as the elderly can maintain the same life-style to which they've been accustomed, they are able to cope with the problems of aging," says Berezin.
Dr. David Blau, 47, says many old people can be rehabilitated: "Many of the mental disorders of the elderly, contrary to what many believe, are reversible. Even those with permanent brain damage can be helped with supportive therapy. The type of therapy for common upsets like confusion, disorientation, memory loss, and other more serious problems varies in depth and frequency as it does with younger people." Blau is an assistant clinical professor of psychiatry at Harvard Medical School and president of the gerontologic society.
HELP FOR THE DYING
But the elderly do pose special problems.
"They have less reserve with which to cope with their problems," says Berezin. "Frequently, they can't turn to their friends or spouses for support because they are dead or inaccessible. In addition, their options for fulfilling long-suppressed ambitions, such as a 70-year-old woman's desire to have a baby, are severely limited."
The dying elderly need special help because, says Blau, doctors, nurses, and families tend to avoid them. Some elderly people find that pets help combat loneliness. Says Blau: "Anything a psychiatrist can do to make them feel someone cares is a marked service."
STAYING "INVOLVED"
Besides trying to inculcate a belief that one's past life has been relevant and worthwhile, the psychiatrists say, they often can show the dying that their fantasies about death, such as the fear of being abandoned or of suffering the wrath of God, are often based on childhood illusions. The psychiatrists say that death is faced with the greatest equanimity in familiar surroundings.
The key to successful aging seems to be to stay actively involved in life as long as possible. Many men who die soon after retirement are those who couldn't accept retirement because they were "Horatio Alger types who worked mainly because it was expected of them," says Berezin.
Something else that seems to help, these experts say, is planning ahead psychologically – as well as economically – with institutional support. They say this can help ease the trauma of change resulting from retirement in a youth-oriented society that undervalues the rich experience and balanced judgment that the elderly may possess.
COUNSELING FAMILIES
The devastating impact that the loss of their roles can bring to retired men helps explain why suicide is more prevalent in that group than in any other except adolescents, the psychiatrists say. A psychiatrist can try to bolster the self-esteem of those who think their masculinity is threatened.
Psychiatrists often find themselves counseling families struggling to cope with the management of the aging at least as much as they counsel the elderly themselves. Relatives of the dying often are overwhelmed and driven to escapist behavior by "anticipatory grief" that cannot be resolved because death and loss have not yet occurred.
SOME CHILDREN TOO SOLICITOUS
Says Berezin: "If the rest of the family is upset, it will be communicated to the dying person." A family conference before death in which the realities of the situation are explained can be helpful, the psychiatrists say. A professional counselor can be of value if he understands the family's sense of helplessness and gets the relatives to admit that they're upset. A dying person feels better if he or she knows others are concerned.
One widespread belief that Blau has challenged is that children often unload their aging parents on institutions and society. To the contrary, often they are overly solicitous, he finds,
TERROR OF NURSING HOMES
While most nursing homes concentrate on custodial care, the importance of personnel trying to understand the behavior of elderly residents is emphasized in annual seminars that the society conducts for nursing-home employes. The seminars also are designed to increase the professional self-esteem of nursing-home personnel in an industry beset by low morale and high employee turnover.
The gerontologic psychiatrists say an elderly person is often terrified of entering a nursing home because of the industry's poor image. The nursing home also represents a "closed door" that marks the approaching end of their lives.
Says Dr. Stanley Cath, a recent seminar speaker: "At least until recently, within a year one-third of the new residents would be dead because of their rage at being abandoned and the fear they would not be kept if they expressed their feelings."
One way to ease the shock of relocation, these experts agree, is to involve the elderly person in the choice of a nursing home and to have a "greeter" present when someone new arrives. In addition, a staff should try to make new residents feel that it is acceptable for them to express their feelings.
Nursing-home personnel need to know everything they can about a new resident and his or her background and personality to assure suitable matching of roommates and proper respect for the new resident as a person. "A new resident should be allowed everything of his own past life, such as his own bed, pictures, alarm clock, to help him or her retain a sense of identity," says Cath.
COUNSELING THE DYING
He concludes that "residents are human organisms that need to replace lost relationships with members of the staff in the attitude, 'I care for you; you have meaning.' This attitude doesn't happen by itself."
The nursing-home resident facing death wants to feel competent in dealing with the present, writes Dr. Bernard A. Stotsky. More than that, he or she needs the assurance that someone else, such as a clergyman, "comprehends what he is undergoing and has also soberly weighed and deeply felt the central issues of loneliness, abandonment, and expectation and fear of death."