Behavioral, Social and Mental Health Aspects of Home Care for Older Americans

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Abstract
Ninety-five percent (95 percent) of the elderly live in the community. At least five million of them need help with activities of daily living. Eighty percent have one or more chronic illness. Eighteen to 25 percent of the elderly have significant mental symptomatology. Only four percent of the elderly visit the community mental health centers (Ernst 1977; Talbott 1985). The primary providers of mental health services to the elderly are the general practitioners, the primary health care nurse, the home health aide psychiatric social workers, members of the family, and a few clinical geropsychologists (German 1987). Over half of the home health care clients are elderly. The primary home health care providers are "challenged" in providing comprehensive health services to the elderly in their homes--often because of a lack of training of the primary home health care provider or because of lack of access because of agencies' policies regarding the acceptance of patients with behavioral, social and mental disorders, including Alzheimer's disease. In this paper, I have profiled the behavioral, social and mental health needs of the elderly with physical illnesses as well as those with behavioral, social and mental disorders. I have dealt with those specific conditions which home health care providers and families find specifically challenging and worrisome, namely: Delirium (confusional states) Suicidal ideation and attempts Psychological assessment Dementia of Alzheimer's type Depression Delirium: (confusion and other behavioral problems associated with hip fractures) Psychotropic drug interaction Wandering Every effort must be made to respect the privacy of the elderly, protect the elderly from research risk, get informed consent when indicated, provide counseling and always assure a high quality of care and supervision. There must be a current plan of care in which both the patient and family participate when feasible. Every effort and plan of care must focus on the maintenance of independence and self-care capabilities and prevention of excessive disabilities.

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