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    The Nurturing Environment Model Handbook
    The Nurturing Environment Model Handbook
    The Nurturing Environment Model Handbook
    Ebook92 pages1 hour

    The Nurturing Environment Model Handbook

    By Dr. Amir Levine

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    About this ebook

    The Nurturing Environment Model (NEM), presented in this handbook, holds that older age provides a unique opportunity for self discovery, awareness, and growth not seen in any other age group. The growth can be multidimensional and rich in its focus, developing clarity on the past, present, and future. The NEM method incorporates a variety of ps

    LanguageEnglish
    PublisherAmir Levine
    Release dateDec 8, 2020
    ISBN9781087931111
    The Nurturing Environment Model Handbook

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      Book preview

      The Nurturing Environment Model Handbook - Dr. Amir Levine

      Some of us are surprised to learn about the mental health needs of older adults and are not aware of our own biases in the way we view this population. Due to older people’s growing physical fragility, we tend to focus our attention on the physical aspects of their care while neglecting their emotional, psychological, and social needs.

      It is vital that, as clinicians, we become aware of the importance of the mental health needs and overall wellbeing of older adults so that we can treat, educate, and advocate for their psychosocial care, incorporating their mental, social, and physical treatment in our support.

      Statistical data shed light on the importance of focusing on the mental health needs of older adults.

      According to the December 2017 report, World Health Organization on Mental Health of Older Adults; data from the 2018 Alzheimer’s Disease Facts and Figures; and the American Psychological Association:

      Over 20 percent of adults aged 60 and above suffer from a mental or neurological disorder. The most common of these are depression and dementia.

      As many as 20 percent of older adults and up to 37 percent of nursing home residents suffer from depression.

      About 70 percent of all primary care visits are driven by psychological factors (i.e. stress, depression), which points to the fact that medical, psychological, emotional, and social factors are inextricably linked. Many older adults will initially report their symptoms as physical, but through further inquiry we can find the psychological, emotional, and/or social issues that may enhance or trigger medical complaints and visits.

      While older adults make up 13 percent of the population, they account for 25 percent of the people who commit suicide, making depression more likely to be lethal for this group. Therefore, it is essential that clinicians and medical providers assess for depression with older adults. Family members should also be encouraged to identify symptoms of depression and encourage those afflicted to reach out for support. [A validated and useful depression screening tool for older adults is the Geriatric Depression Scale, which can be found in the appendix of this handbook.]

      It is staggering that one in six adults over the age of 60 has experienced some form of abuse and exploitation during the past year. It is vital that clinicians assess for safety with all older adults and inquire about relationships and commitments that may be suspicious and exploitative in nature. [A validated and helpful abuse screening tool is the Elder Abuse Screening Index (EASI), which is located in the appendix of this handbook.]

      A statistic that may be surprising for some is that substance abuse is one of the eight leading causes of death for older people, and it is estimated that 17 percent of this group misuses and abuses alcohol and medications. Therefore, it is as important to inquire and assess for substance abuse with older adults as it is with any other client population, and ensure the proper use of their prescribed medications. [A validated and helpful screening tool that clinicians can use to assess for alcohol abuse is the Short Michigan Alcohol Screening Test—Geriatric Version (SMAST-G), which you can find in the appendix of this handbook.]

      It is estimated that one in six women and one in ten men will develop dementia during their lifetimes.

      One in three seniors dies from complications associated with dementia, and it kills more people than breast and prostate cancer combined. Initial screenings are important for the best outcome. [A validated and helpful abuse screening is the Washington University Dementia Screening Test, which is located in the appendix of this handbook.]

      Thirty percent of people over the age of 85 are afflicted with dementia. Often times with dementia comes a wide range of psychiatric symptoms, such as paranoid ideations, psychotic features, aggression, and depression, placing a great toll on clients and their caregivers. As such, there is a great need for mental health services among this population.

      It is important that clinicians focus on monitoring and assessing older adults’ mental health, substance abuse, vulnerability to exploitation/victimization, and risk for dementia. As we will discuss, older people’s vulnerability is three-fold:

      First, they present with an interconnected range of psychological, emotional, social, and health-related issues that initially may masquerade as physical symptoms.

      Second, due to social biases, older adults tend to be overlooked and ignored as a population when it comes to assessment and management of psychosocial aspects of care. Clinicians working with older adults need to be aware of societal biases and their own prejudices when it comes to this population. Awareness of biases can greatly enhance our ability to work them through and enhance our effectiveness as clinicians and agents of change.

      Third, older adults have to grapple with their own biases and stigmas about mental health, seeking help, and psychotherapy. Some in this group grew up in times where psychotherapy was for crazy people and depression was considered a moral weakness. As we will discuss in later chapters, clinicians working with older adults can work toward de-stigmatizing and educating clients on the benefits of psychotherapy.

      I hope that those reading this book who treat older adults will make sure to conduct a thorough and thoughtful assessment of their clients.

      The approach and perception of psychotherapy with older adults has evolved significantly.

      Sigmund Freud is quoted as saying in the early 1900s, "Near or above the age of fifty the elasticity of the mental processes, on which the treatment depends,

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