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Melanie Cole (Host): The aging process can complicate the diagnosis and treatment of unique mental health needs that older adults sometimes face. Lourdes Senior Behavioral Health Program helps older adults and their families understand and learn to manage these challenges. My guests today are Esther Annon and Amy Brennan. Esther is the Clinical Assessment Coordinator and Amy is the Community Education Manager at the Senior Behavioral Health Program at Lourdes Medical Center of Burlington County. So, Esther, I'd like to start with you. Please kind of go over for us some of the challenges that these older adults and their families face as they start to become maybe a little bit toward dementia, maybe not Alzheimer's. Tell us some of the challenges.

Esther Annon (Guest): Sure. Sure. Well, you know, we know that dementia is fluid. It isn't something that is immediately diagnosed. Sometimes, it can be confusing. It may be masked by other medical issues, mental health issues and so there's a lot of confusion, right? There's a lot of fear. We also know that mental health issues in older adults are largely undiagnosed and that, in fact, the World Health Organization estimates that one out of four people age 55 and older may have some type of mental health concern, so it can be difficult to identify the etiology of whatever behavior or symptom we are observing. And so, what we try to do is clarify the situation, educate the patient and the family, and then help them identify what the best setting would be to treat their loved one in. That very well may be in the inpatient setting.

Melanie: So, Esther, I'm going to stick with you a second as you are the Clinical Assessment Coordinator. When would it be that you would tell families some red flags for their elderly loved ones? When would they come to see you for some assessment?

Esther: You know, so when we talk about someone that sort of meets criteria for an inpatient admission, and inpatient admission is reserved for kind of as a last resort, right? We always want to try to keep people in the community, in the place that's most familiar and comforting to them until it's absolutely not possible. So, we talk about when there comes a time when the patient may be a danger to themselves, may be a danger to others, may not be able to function for whatever reason. These are times when you start to ask yourself that question and you come up with the answer of "yes," you know, they are a danger to others, they are a danger to themselves, they are not able to function, and we need help. That is a time to call. That is a time to call.

Melanie: So, Amy, tell us about the new Senior Behavior Health Program at Lourdes Health System.

Amy Brennan (Guest): We are a 20-bed program at Lourdes Medical Center of Burlington County, which is located in Willingboro, NJ. We utilize a short-term treatment approach for older adults who are experiencing a behavioral and/or emotional problems. They benefit from group activities, treatment, individual therapy with our social worker and our medical director, Dr. Rothman.

Melanie: So, tell us a little about what they can expect when they get there if their loved ones bring them there and are they sometimes resistant?

Esther: To answer your question, absolutely. Families are often reluctant. We know that mental health issues are stigmatized. Older adults, being from a different generation, don't seek help often for a variety of reasons but what we try to do is myself, Amy, and others, we educate them about what they're going to receive here. Here on our unit, we believe in active treatment. We utilize a multi-modal approach, so as Amy was mentioning, we have a full-time recreation therapist who helps them develop positive coping skills, learn stress management techniques, utilize leisure therapy to really work towards a healthy lifestyle, we have social work groups where we focus in on reminiscence or grief and loss, cognitive behavioral strategies, psychoeducation, creative expression. So, these are some of the things that we do here. Dr. Rothman, as Amy mentioned, is extremely involved. He meets with every patient, every single day. We have family meetings routinely. The nurses and the PCAs are extremely involved as well and they run groups, education about the different diagnoses, and the medications that they're being prescribed and are encouraged to take.

Melanie: So, Amy, tell us about that family education. What do you do for families to help them understand what their loved ones are going through? How do you educate them about these processes?

Amy: So, my role as the Community Education Manager is, again, to educate the community on the different aspects of mental health. So, I can either do that through presentations at church groups and facilities, at family nights, at assisted living, or a skilled nursing facility. I recently, along with Esther, we presented at a facility on depression in older adults and then I also presented the same end service at a church group through the parish nurses. So, it's a lot of education on the different mental illnesses and what they can look for and how to ask for treatment, and where to call for treatment. And, even with the referral sources, letting them who and when they should reach out to our programs for any of their residents or loved ones or, you know, friends and family.

Melanie: And, Esther, with this multi-disciplinary team that you've got there at the behavioral health program, explain a little bit about the tiers or if someone comes in and they're pretty sharp when they come in but they start to decline a little bit, then how does it change? How does their lifestyle there change?

Esther: That's a good question. You know, it really is, we have to look at that unique individual and we start by gathering a lot of information about what was occurring in their life before their hospitalization; what might have triggered this event. What were they like before they were having difficulty? What are some possible “precipitating events”, we call them. And then, we really try to peel away the layers of the onion, if you will, and help the patient adjust to their new normal, or their new situation, and you know, it's tough to talk so generally like that, because, as we know, each person deals with very unique challenges in their lives, and so it's hard to say. One person may be very resilient in dealing with the loss of a loved one, for example, and another doesn't have those coping skills and may be very affected by the fact that they've had to move out of the home that they lived in for 20 years and are having difficulty adjusting with that. There may be other contributing factors that have led to this current crisis that they're in. And so, we really look at the person and environment and try to tailor our treatment plan to that unique individual. For one person, medication management may be the sort of the magic pill, and in others, it may be more behavioral and learning coping skills and environmental. That might have everything to do with their recovery and how we help them.

Melanie: Amy, is this a short-term treatment approach? How long, generally, do you keep a patient there?

Amy: Yes, it is short-term and it varies based off of the patient, the diagnosis they have and how they are responding to the treatment.

Esther: And I'd like to add, you know, we don't have a hard and fast rule. We are short-term. You know, sometimes families may be in crisis and they really are in need of respite and may want their loved one to stay for an extended period of time and we really work with them to acknowledge that. Obviously, the hospital isn't the best place long-term for someone and what is the next setting for them that is really going to empower them to live the best lives that they can? And that's something that we can assist with, as well.

Melanie: So, Amy, I'd like you to wrap up your portion of this with the Community Education portion of it. What do you want the community and listeners to know about these challenges that they may face with their loved ones? What do you tell them when you give these presentations about recognizing some of these things?

Amy: That the aging process can complicate the diagnosis and treatment of unique mental health needs and life challenges that older adults can find difficult to overcome; that there is help out there and they don't have to be afraid to ask. There are so many avenues and options if they need it, that all they have to do is to call and ask a question and ask for help.

Melanie: And, Esther, wrap it up for us with your best advice about seniors and some of these issues that they face, whether they're delusions, or they're getting forgetful, or they have some confusion, or they're aggressive and all of these things that might start to happen to our loved ones and give us a good wrap up about the Senior Behavioral Health Program at Lourdes Medical Center?

Esther: Absolutely. Well, we recognize here that mental health issues in older adults looks different than it may in others, in younger people, and there are many reasons why older adults do not seek help. They may have difficulty sharing these feelings, even cognitive, memory problems may make some people feel uncomfortable sharing. They may be dealing with multiple changes and losses. Sometimes, the mental health issue is masked by another illness that may have been mistakenly viewed as a side effect of something else. So, there are so many issues contributing but what we know is if you neglect your mental health, physically, you will pay a price and, in fact, it will affect you physically. And so, you are not alone, as Amy said, talk to your doctor, consider different treatment options, call us. There are many, many ways to help and many people now, as they are educated, are reaching out for help and feeling better because of it.

Melanie: Thank you so much, ladies, for being with us today. It's such important information for listeners to hear. For more information on the new Senior Behavioral Health Program at Lourdes Medical Center, you can go to www.lourdesnet.org. That's wwww.lourdesnet.org. You're listening to Lourdes Health Talk. This is Melanie Cole. Thanks so much for listening.