Canadian Coalition For Seniors’ Mental Health
Canadian Coalition forSeniors’ Mental HealthMental Health Issuesin Long-Term Care Homes:a guide for seniors and their familiesBased on the Canadian Coalition for Seniors’Mental Health (CCSMH) National Guidelinesfor Seniors’ Mental Health: The Assessment andTreatment of Mental Health Issues in Long-Term CareHomes (Focus on Mood and Behaviour Symptoms).
Production of this guide has been made possible through afinancial contribution from thePUBLIC HEALTH AGENCY OF CANADA.Disclaimer: This guide is intended for information purposesonly and is not intended to be interpreted or used as a standard ofmedical practice.Canadian Coalition for Seniors’ Mental Health ( CCMSH )Kim Wilson, Executive DirectorSherri Helsdingen, Project ManagerAddress: c/o Baycrest3560 Bathurst StreetRoom 311, West Wing, Old HospitalToronto, ON M6A 2E1Phone:416-785-2500 ext. 6331Fax:416-785-2492Web:www.ccsmh.ca 2009 Canadian Coalition for Seniors’ Mental HealthAcknowledgementsThe CCSMH is grateful to the following people – health careprofessionals, older adults and family members – who participatedin the review of this booklet:Dr. David K. Conn (Baycrest & University of Toronto, Co-Chair ofthe CCSMH), Dr. J. Kenneth Le Clair (Providence Care & Queen’sUniversity, Co-Chair of the CCSMH), Scott Dudgeon (AlzheimerSociety of Canada), Laura Evans (Canadian Mental Health Association),Beth Floyd (Seniors Advisory Committee, Mental Health Commissionof Canada), Dr. Maggie Gibson (St. Joseph’s Health Care London),Jackie Hogan, Maureen Lynn (Yee Hong Centre for Geriatric Care), Dr.Penny MacCourt (British Columbia Psychogeriatric Association), NonaMoscovitz (CSSS Cavendish), Simone Powell (Public Health Agencyof Canada), Gregg Schiller (411 Seniors Centre Society), RhondaSeidman-Carlson (Markham Stouffville Hospital Corporation) andMarjorie Silverman (CSSS Cavendish).Table of ContentsIntroduction.1Definitions.3What are long-term care homes?.5Promoting health in long-term care homes.6General care in long-term care homes:activities of daily living.7Information about my family member.8Understanding mental health problemsin long-term care residents.10Treating depression in older long-term care residents.12Improving lifestyle and social supports.12What about residents with depression and dementia?.14Medication.14Treating behavioural symptoms in older long-termcare residents.15Improving lifestyle and social supports.15Medication.17What role can family members play in long-term care?.18A final note about living well and aging well.20Additional resources.21Local resources.25A full list of references is available at www.ccsmh.ca
IntroductionWe’re very glad you picked up this booklet. Canadians are notonly living longer but also staying healthy and independentlonger than ever before. We want all older adults – and theirfamily members – to have high-quality information abouthealth issues that might affect them. We believe that withthis information, older adults will be empowered to makeinformed decisions about their health care and build effectiverelationships with their health care providers.What is the Canadian Coalition for Seniors’Mental Health?The Canadian Coalition for Seniors’ Mental Health (CCSMH)started in 2002 to promote the mental health of seniors byconnecting people, ideas and resources. Members of theCCSMH are organizations and individuals who representseniors, family members and informal caregivers, health careprofessionals, researchers and policy makers.In 2006, the CCSMH created the first set of nationalguidelines on seniors’ mental health based on the most currentresearch. These guidelines were written for health careprofessionals who work with older adults. They recommendways to improve the assessment, prevention, treatment andmanagement of key mental healthproblems for older adults: mentalhealth issues in long-term careThe CCSMH will happily providehomes, depression, suicide andthese resources on request. Calldelirium. This booklet is part of a416-785-2500, ext. 6331, orseries that covers the same topicsfor seniors, their family members,visit www.ccsmh.ca to downloadand others who care about them.them at no cost.1Mental health problems are NOT a normalpart of agingMany people think that mental health problems are justa normal consequence of aging. This simply isn’t true.Difficulties with mood, thinking and behaviour are notan inevitable part of aging. Nor are they signs of personalweakness. They are usually signs that something is wrong thatrequires attention from a health care professional.Some people may argue that there is no point investigatingthese problems in older adults because these problems can’tbe fixed. Some problems associated with aging cannot becured yet, but there is still a lot that can be done. Mentalhealth problems can be treated.Older adults experiencing changes in their mood, thinkingand behaviour may not be aware of the changes that aretaking place, may misunderstand the nature of the changes, ormay be ashamed of the idea that they’re developing “mentalhealth problems.” Family members may misunderstand andthink that these changes are normal parts of aging, aspects oftheir relative’s personality or signs of personal weakness, andthey may not know how best to help.We hope this guide will help informolder adults and their families aboutwhat they can do if they have mentalhealth concerns.Who should use this guide?This guide will help the familymembers of an older adult living in a long-term care facility.It will also help older adults who are preparing to move toone. It gives information about mental health issues thatare common among residents of long-term care homes andsuggests strategies to improve their quality of life.CCSMH Mental Health Issues in Long-Term Care Homes2
DefinitionsAgeism is a way of thinking about older people based onnegative attitudes and stereotypes about aging. Ageism canlead to age discrimination – treating people in an unequalfashion because of their age. Age discrimination cannegatively affect older adults in all aspects of life.Mental health is the capacity of each person to feel, thinkand act in ways that allow them to enjoy life and deal with allthe challenges they face.The terms “seniors” and “older adults” are used in thisguide to refer to individuals over the age of 65.Stigma is defined as a mark of shame or disgrace. It ofteninvolves stereotypes, hurtful words and discrimination.Stigma around mental health is often based on society’smisunderstanding and lack of knowledge about mental healthproblems. Many people living with mental health problemssay that society’s negative reactions to them can be worsethan the illness itself. Because of the stigma of mental healthproblems, many people don’t seek – or receive – the healthcare they need.3Delirium is a confusionalstate. This means thatAll three of these conditions canpeople with delirium areoccur at the same time. It helps todisoriented, with an alteredunderstand the differences betweenlevel of consciousness andthese conditions so that you cantrouble understanding theenvironment. Deliriumidentify them and get the properdevelops quickly over ahelp right away.period of hours or days.The symptoms of deliriummay come and go and are often worse at night. Deliriumis a medical emergency caused by difficulties in brainfunctioning.Dementia is an illness characterized by the loss of intellectualabilities that is severe enough to interfere with a person’sability to function. Dementia results in changes in the waythe person thinks, feels and behaves, along with memoryimpairment. It tends to develop slowly over a period ofmonths or years and progresses over time. Alzheimer’sdisease is an example of dementia.Depression can cause people to feel persistently low in spiritsand lose interest in things that used to give them pleasure.This is sometimes triggered by stressful events in a person’slife that impact their state of mind, their health, or their abilityto connect with other people. However, sometimes it canhappen for no apparent reason. When a person is severely(i.e. clinically) depressed, the chemicals in his or her brainmay be out of balance. Other symptoms often include sleepand appetite changes and anxiety.CCSMH Mental Health Issues in Long-Term Care Homes4
What are long-term care homes?Promoting health in long-term care homesIn this guide, “long-term care homes” refer to any residencesfor older adults who need assistance with daily activitiesand require skilled nursing care on a daily basis. Long-termcare homes are also called “nursing homes,” “personal carehomes” or “complex care facilities.”The staff in long-term care homes provide residents with:In Canada, the provinces and territories are responsible forlong-term care. As a result, long-term care services andfacilities vary across the country.Who lives in long-term care homes?Older adults who live in long-term care homes often havedisabilities. They need a lot of care and assistance with dailyactivities.Most residents of long-term care homes also have some typeof mental health problem. Research shows that more thanhalf of residents may have dementia and other cognitiveimpairments. Some residents in long-term care homes mayalso suffer from depression and psychosis.People with dementia may have some of the followingbehavioural symptoms: Agitation Aggression Wandering ShoutingAlzheimer’s disease is the mostcommon form of dementia.For more infomation, go towww.alzheimer.ca Repetitive or bizarre behaviour Making rude or hurtful comments Sexually inappropriate behaviour5 The general care residents require for activities ofdaily living. The care that is needed to manage and treat mood andbehavioural symptoms.The following principles promote the mental health ofresidents with mental illness. They also promote the generalhealth and well-being of all residents in long-term care: Residents should receive personalized care. Wheneverpossible, care should be based on the directions andpreferences of the resident. Families should be considered partners in care. Care should focus on the resident’s strengths andminimize the impact of his or her limitations. Care should take into account the physical, mental,social and spiritual needs of the resident. Staff should receiveongoing education andtraining to provide care toresidents. A supportive and helpfulenvironment should becreated that responds tothe resident’s changingneeds.If you, or someone you know, hasa concern about the way care isbeing provided, you can use thisguide to help start a conversationwith staff. All long-term care homesare also required to post a complaintprocedure. Strategies to preventmental illness should be built into programming andincluded in training programs for staff and families.CCSMH Mental Health Issues in Long-Term Care Homes6
General care in long-term care homes:activities of daily livingActivities of daily living include tasks like bathing, gettingdressed, going to the bathroom, and eating. If an older adult isno longer able to do these things independently, this can leadto a decision to move into a long-term care home.Older adults who have physical or mental health problemsmay not be able to perform these daily activities likethey used to. They may become agitated, restless or evenaggressive. This can be an expression of an unmet need. Theymay be hungry or in pain or need to use the bathroom.It is easy to understand why people who are not havingtheir basic needs met may act out. Even if a person’sneeds are being met, it’sunderstandable that theymay feel uncomfortableabout the way things arebeing done.It can be very hard forfamily members towatch someone they carefor become agitated oraggressive. The good newsis that family members canhelp. An individualized care plan is created for each longterm care resident. Family members can tell staff about theolder adult’s routines and care patterns before the relativemoves into a long-term care home. Sharing this type ofinformation with staff can greatly improve the care that isdelivered. This is especially important for older adults whoare unable to express themselves verbally. Family memberscan help create the individualized care plan by completing theform on the next page.7Information about my family member:Do they have a dementia? o Yeso Noo Not sureIf yes, please describe:Are they depressed? o Yeso Noo Not sureHave they been delirious before? o Yes o No o Not sureDo they have a new illness(es)? o Yes o No o Not sureIf yes, please describe:Doctor’s name:Doctor’s phone number:List all medications ( prescribed, over-the-counter, andany herbal remedies ):Behavioural symptoms:o agitationo aggressiono wanderingo repetitive or bizarrebehaviourCCSMH Mental Health Issues in Long-Term Care Homeso shoutingo making rude orhurtful commentso sexually inappropriatebehaviouro other8
Information about my family member:How were these symptoms managed in the past?Social history:Marital status:Where do family members live:Religion / faith:Country of birth:First language:Other:Personal escribe their daily routines: (housekeeping, mealpreparation, social contacts, hygiene, etc.)Understanding mental health problems inlong-term care residentsAll residents should be screened for depression andreasons for changes in behaviour shortly after they moveto the long-term care home. Screening also occurs on aregular basis (annually) and in response to any significantchanges, like the death of a spouse, or when a resident losesthe ability to do their usual activities.Screening is done to detect symptoms so that they can beinvestigated and to ensure that prevention methods aremaintained. Families may be involved in the screeningprocess, especially if a resident is unable to speak forthemselves. As partners in care, family members shouldfeel comfortable speaking with the long-term care staff. Iffamily members notice changes in their relative’s mood andbehaviour, this should prompt a re-screening.If the screening shows that the older adult might be depressed,a more detailed investigation should occur. This can involvea review of the older adult’s medical history, a physical examand laboratory tests. The purpose of this detailed investigationis to look for any other conditions that may impact theresident’s mood and behaviour, such as a medical disordercausing a delirium, dementia or depression.Focusing on what the resident is stillable to do, instead of what they canno longer do, can help to improvetheir quality of life.What is important to them?9CCSMH Mental Health Issues in Long-Term Care Homes10
Changes in the social environment of a long-term careresident can affect their mood and behaviours. Such changesmay include: Changes in the family situation New stressors or situations, like a change in staffing at thehome Changes in patterns and schedules Changes in the physical environment, such as a change inroomsIf you are a family member of a long-term care resident andyou are aware of any changes in the social environment ofyour relative (especially changes that may be happeningoutside of the long-term care home, like an illness in thefamily), it may help to share this news with a staff member.Treating depression in older long-termcare residentsIf a resident in long-term care has demonstrated certainsymptoms (such as a change in mood, feelings of sadnessthat won’t go away, a loss of appetite, lost interest in thingsthey used to enjoy, among other symptoms), he or she maybe diagnosed with depression. Depression is very commonamong long-term care residents. Some research shows thatup to 40% of residents may be experiencing symptoms ofdepression.Although depression is common among older adults, it isimportant to remember that depression is NOT a normalpart of aging. Symptoms can be treated in almost all cases!The resident’s treatment planshould be created based onthe type of depression andhow severe it is. Treatmentshould include lifestylechanges and social supportand may include the use ofmedication.More information on depression isavailable in the CCSMH Depressionin Older Adults: a guide forseniors and their families. Visitwww.ccsmh.ca or call 416-785-2500,ext. 6331, to get a copy.Improving lifestyle and social supportsHealth care providers, family and volunteers can providepsychosocial support for long-term care residents.Psychosocial support refers to the creation of a supportiveenvironment where practical and emotional support is offered.This type of support can improve the older adult’s mood andbehaviour.11CCSMH Mental Health Issues in Long-Term Care Homes12
The chart below shows different types of support that somelong-term care residents have found useful. It is important toremember that not all activities will be effective or welcomedby all residents. Support should be tailored to the needs andwishes of the individual resident.Goal of careReduce symptoms ofdepressionActivities to considerOpportunities to meet, talk andsocialize with others Weekly visits from family or avolunteer Spiritual care from a minister,rabbi or other faith leaderEngage resident Supportive therapyStructured, meaningfulrecreational activities Recreation based on theresident’s interests and abilities(like baking, music anddiscussing current events) Appropriate exerciseCounselling and therapy can also reduce the symptoms ofdepression and increase a person’s sense of self-worth andoverall well-being. Therapy should always be provided by atrained specialist.Each resident is unique. It’simportant to offer support in a spiritof collaboration and respect.13What about residents who have depression anddementia?It is common for residents who have dementia to also showsymptoms of depression, and vice versa. When treatmentstrategies are being considered, it is important to think aboutthe resident’s ability to understand and their willingness toengage in activities. This will help avoid unintended agitationand distress.Since dementia worsens over time, it’s important to beflexible. An activity that reduced the symptoms of depressionin the past may no longer work. Various strategies may beused for residents with both dementia and depression. Mostare one-on-one activities. Some examples include: Supportive therapy Playing a recording (for example, a CD or DVD) ofpositive experiences from the resident’s life and sharedmemories involving family andfriends Physical activity Prompting personal memoriesabout relationships, family, workand life accomplishments (thismight happen during meal times)MedicationAn older adult and health care provider may decide onmedication as a way of treating depression. For olderadults with depression who live in long-term care homes,antidepressants are the medication of choice. It is often best ifantidepressants are used along with a combination of lifestyleimprovements and social supports. More information on thedifferent types of medications used to treat depression in olderadults can be found in the CCSMH depression guidelines.CCSMH Mental Health Issues in Long-Term Care Homes14
Treating behavioural symptoms in old
5 CCSMH Mental Health Issues in Long-Term Care Homes 6 Promoting health in long-term care homes The staff in long-term care homes provide residents with: The general care residents require for activities of daily living. homes” or “complex care facilities.” The care that is needed to manage and treat mood and behavioural symptoms.
The Assessment and Treatment of Mental Health Issues in Long Term Care Homes MAY 2006 CANADIAN COALITION FOR SENIORS’ MENTAL HEALTH COALITION CANADIENNE POUR LA SANTÉ MENTALE DES PERSONNES ÂGÉES Long Term Care Homes . Practices Conference: Focus on Seniors’ Mental He
Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
INTRODUCTION TO SMARTPHONES Part 2 BEGINNERS GUIDE TECH SAVVY SENIORS The NSW ' Tech Savvy Seniors ' program is a key initiative of the NSW Ageing Strategy and the Telstra Digital Literacy Strategy. 'Victorian Tech Savvy Seniors ' is a Seniors Card Age Friendly Partners program with Telstra delivering training through rural and remote libraries across Victoria.
10 tips och tricks för att lyckas med ert sap-projekt 20 SAPSANYTT 2/2015 De flesta projektledare känner säkert till Cobb’s paradox. Martin Cobb verkade som CIO för sekretariatet för Treasury Board of Canada 1995 då han ställde frågan
service i Norge och Finland drivs inom ramen för ett enskilt företag (NRK. 1 och Yleisradio), fin ns det i Sverige tre: Ett för tv (Sveriges Television , SVT ), ett för radio (Sveriges Radio , SR ) och ett för utbildnings program (Sveriges Utbildningsradio, UR, vilket till följd av sin begränsade storlek inte återfinns bland de 25 största
Hotell För hotell anges de tre klasserna A/B, C och D. Det betyder att den "normala" standarden C är acceptabel men att motiven för en högre standard är starka. Ljudklass C motsvarar de tidigare normkraven för hotell, ljudklass A/B motsvarar kraven för moderna hotell med hög standard och ljudklass D kan användas vid
LÄS NOGGRANT FÖLJANDE VILLKOR FÖR APPLE DEVELOPER PROGRAM LICENCE . Apple Developer Program License Agreement Syfte Du vill använda Apple-mjukvara (enligt definitionen nedan) för att utveckla en eller flera Applikationer (enligt definitionen nedan) för Apple-märkta produkter. . Applikationer som utvecklas för iOS-produkter, Apple .
The theme for the 2021 NSW Seniors Festival is In Our Nature. During challenging times, it’s in our nature to connect. Whether it’s online, or out in the sunshine, NSW Seniors Festival is a chance to come together. NSW SENIORS FESTIVAL 14 - 24 APRIL 2021 SENIORS FESTIVAL Launch
