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Behavioral Gerontology

Behavioral Gerontology. Linda LeBlanc and Allison Jay. Aging in America. The proportion of the population over age 65 in the U.S. has risen from 4% to 13% in the 20 th Century Predicted to be 20% of the population by 2030 Many factors contribute

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Behavioral Gerontology

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  1. Behavioral Gerontology Linda LeBlanc and Allison Jay

  2. Aging in America • The proportion of the population over age 65 in the U.S. has risen from 4% to 13% in the 20th Century • Predicted to be 20% of the population by 2030 • Many factors contribute • Medical advances have increased life expectancy • 1900: 47.3 years • 1950: 67 years • 2000: 76 years • Aging of Baby Boomers

  3. Effects of Aging • Living longer means a substantial portion of elders live with chronic illness and disability • Higher total cost of care • Greater care needs • Potentially lower quality of life

  4. Behavioral Gerontology • Application of behavioral theory and principles to aging issues • Clinical/Rehabilitation Issues • OBM/Staff Training Issues • Small sub-field of behavior analysis that needs new interested students • Check out the Behavioral Gerontology SIG at ABA • Different approach to aging from typical medical model of inevitable biological decline

  5. Behavioral Gerontology • From a behavioral perspective, when a person ages • Fewer discriminative stimuli control behavior • Different establishing operations are likely • Contingencies of reinforcement tend to support the wrong behaviors • Leads to behavioral deficits like • memory problems, incontinence, over-dependence • And behavioral excesses like . . .

  6. Need For Behavioral Gerontology • Behavior Excesses (Behavior Problems): • Aggression, Wandering, Repetitive vocalizations • Behavior problems are • Major cause of caregiver stress • The most common cause of institutionalization • Not a health decline but “can’t take it anymore” on the part of the caregiver • Very common in nursing homes • 64% have significant problems (Zimmer et al, 1984) • Can lead to high staff turnover

  7. Obstacles to widespread behavioral services • Practitioners are reluctant to serve elders – no training • Older people and caregivers perceive stigma for accessing mental health services • Older adult: means “I’m crazy” • Caregiver: “a good son/daughter/wife/husband” could handle it without help • Medical Model Myths • Psychotropic medications are the only thing that will work - most common intervention • Once a skill is lost it cannot be regained • Cost and effort constraints • Simple and/or cheap will always be selected

  8. Common mental health problems for elders • Depression and Anxiety • Dementia related behaviors • Losses or declines in memory, conversation, socialization, and activity engagement • Incontinence • Increases in problem behaviors • Aggression • Repetitive Vocalizations • Wandering

  9. Anxiety and Depression • Often undetected in elders because • Physicians and patients fail to recognize it • Focus on physical symptoms rather than mental health • Emotional issues are reported as physical symptoms (e.g., fatigue, heart rate problems) • View it as typical aging to be sad and worried • Anxiety • About 6% of healthy elders have clinical anxiety (APA, 1998) • Higher rates in elders with medical conditions • Depression • Occur in 2 - 10% of older adults; 2x more in women • 30-50% of people in nursing homes

  10. Behaviorally . . . why • Depression and anxiety might increase because . . . • Motivative operations • Reinforcer availability/loss • Discriminative stimuli • Others

  11. Behavior Therapy • Individual or group based therapy that focuses on the role of: • Activity and social engagement • Access to reinforcers for non-depressed behaviors • Negative self-statements • Problem – solving skills • Elders who complete therapy tend to benefit as much or more than younger adults • Often a preference for group therapy

  12. Nursing Homes • Depressed affect can increase risk of nursing home placement (Cohen-Mansfield & Wirtz, 2007) • Nursing homes • Absence of meaningful opportunities for engagement • No social interaction or conversations • Increased depression and memory problems • High rates of problem behavior • Excess disability • Behavioral gerontologists have tackled each of these problems successfully

  13. Bourgeois (1993) • “Effects of memory aids on dyadic conversations of individuals with dementia” • Patients with dementia appear incoherent in conversation because they • Substitute vague words for specifics • Drop out content and theme • Cannot spontaneously generate topics • Interventions such as memory wallets result in better conversations

  14. My Nieces:Caroline, Courtney, Jessica

  15. My favorite color is blue. My cat is Mr. Snuffles and he is a Siamese.

  16. I live at 427 Bloomfield Ave

  17. Bourgeois (1993) • Two demented patients in conversation • Participants: 5 women & 1 man at adult day care centers • Memory aid for one of the two was used in each conversation • Interviewed family members to develop list of facts and topics • Took corresponding pictures to include in wallet • 5 minute conversations 3 times per week • Measured on-topic statements and statements related to the memory aid

  18. Bourgeois (1993) • Research design = • Reversal (BAB) • Effects • Noticeably more on-topic statements related to aids and to other areas (except one) for target client • Also more for the partner - it wasn’t their aid! • Least effects were when both partners were extremely impaired • Social Validity • 13 Speech Staff listened to tapes and rated quality • Aided conversations rated higher on staying on topic, ambiguity, comfortability,

  19. Heard & Watson (1999) • Targeted wandering in demented individuals in nursing homes using a functional behavioral approach • Tracked wandering in 35-40 minute episodes; in how many intervals did it occur • Found different reasons or functions for why wandering occurred • Attention • Access to food • Sensory stimulation • Used that reinforcer in a DRO procedure to decrease wandering

  20. Research Design = • Reversal (ABAB) • Effects = • Clear effects for each participant • Decreased intervals with wandering by ½ for each participant • What implication for this continued level of behavior?

  21. The Intersection of Gerontology and OBM • Direct care staff in nursing homes • Are called CNAs (Certified Nursing Assistant) • Are often receiving low pay and working long hours • Have many potentially unpleasant aspects to their job • Are often kind people who sincerely want to help • Often have no idea that their actions are directly contributing to an environment that • Suppresses independence and activity • Reinforces problematic behavior

  22. The Intersection of Gerontology and OBM • Staff training and performance monitoring are a critical part of providing good care in nursing home settings • Staff will often acquire knowledge of procedures in in-service then fail to use the procedures when they interact with clients • No system in place to make it worthwhile or feasible to maintain new procedures

  23. Engelman, Altus & Mathews (1999) • Increasing engagement in daily activities • 5 residents with dementia • Intervention: • CNA training to get staff • Interacting with each client every 15 min • Offering activity choices • Praising activity • Written feedback on CNA performance • Measured appropriate engagement, inappropriate engagement, no engagement • Research Design =

  24. Engelman, Altus & Mathews (1999) • Results = • All participants experienced increased appropriate engagement • over 80% of intervals in morning • over 70% of intervals in afternoon • Greater diversity of activities • 7 in baseline, over 20 in intervention

  25. Engelman, Altus, Mosier & Mathews (2003) • Well meaning staff may increase resident dependence by doing everything for them • System of “Least to Most” Prompts ensures opportunity to perform independently • Verbal • Gestural • Physical • Intervention • Interactive 30 min training on SLP (model, rehearse, feedback) • Feedback on job; Daily Monitoring of Client Performance by CNA

  26. Engelman, Altus, Mosier & Mathews (2003) • Participants: 2 CNAs; 3 elders with dementia • Measured • CNA use of SLP • Time it took to dress*** • Research Design = multiple baseline across participants • Results = • Prompts increased for all CNAs across elders • No increase in time it took to dress elder (6.7 vs. 6.5 min)

  27. Conclusions • Increasing need for professionals with experience and expertise in aging • Opportunity to create new models for service delivery that allow individuals to retain independence as long as possible • Allows you to blend clinical and OBM interests

  28. Practicum in Behavioral Gerontology • New model of service delivery • Day program so they live at home longer • Respite for caregivers • Activities and care for participants • Physical, Medical, Cognitive Disabilities • Active Behavioral Programming • Increased engagement, decreased problem behavior • Advanced Practicum if you do well • OBM and clinical opportunities

  29. Practicum for Psychology Students - WMU • Year round • 3 credit hours Contact Allison Allison.Jay@wmich.edu http://wmu.aging.practicum.googlepages.com/home

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