Eric Pfeiffer

Psychotherapy with elderly patients.

The elderly in our society receive very little intermediate or ambulatory psychiatric care; however, with some modifications in technique, psychiatric care for the elderly can be effective. The special psychologic needs of the elderly require greater activity on the part of the therapist, symbolic giving within the therapeutic relationship, limited goals in therapy, increased awareness of transference and countertransference phenomena, and empathic understanding of elderly patients.

An Evaluation of the Reliability and Validity of the Functional Assessment Inventory

The reliability of the Functional Assessment Inventory (FAI) was evaluated using a sample of VA domiciliary and nursing home patients. The interobserver and interrater reliability coefficients of the summary rating scales, based on a single assessment, tended to be higher than their test‐retest reliability coefficients, based on two independent assessments separated by a modal four‐week interval. Validity coefficients, using the OARS instrument ratings as criteria, also based on two independent assessments several weeks apart, were, on the average, as high as the test‐retest reliability coefficients. More specifically, the mental health, physical health, and activities of daily living rating scales, along with the objectively scored Short Portable Mental Status Questionnaire and Short Psychiatric Evaluation Schedule, tended to yield relatively similar scores with repeated measurement, while the social resources and economic resources scales were somewhat less stable, a discrepancy possibly explained by the homogeneous nature of the social and economic status of most of the patients (institutionalized veterans). Thus the reliability and validity of the FAI are satisfactory, but the stability of some of its scales requires further investigation.

Some Basic Principles of Working with Older Patients

For the past sixteen years I have been working in the field of geriatrics and gerontology. During that time I have discovered a number of basic p i n ciples of how to work successfully with older patients. What I know I have not learned from textbooks, but from the real experts on aging, older people themselves. I would like to share these principles with you in the hope of facilitating your work with older patients. I am also offering these principles as a tribute to all older persons who, in my opinion, constitute a group of elite survivors and pioneers, laboring at the last great frontier: confronting their own aging experience. I have been trained as a psychiatrist. But in that training I was not given one whit of information about geriatric psychiatry, that is psychiatry as it applies to older patients. The field literally did not exist. If I helped to create that field, then I am pleased. But I have gained far more than I have contributed. Moreover, I continue to learn, the ultimate reward for the academician. While speaking as a psychiatrist, I feel that the principles that I will discuss apply to the helping professions generally: to all medical specialties, especially internal medicine, psychiatry, and family medicine, but also to the allied health and the social service professions. In fact, it would be foolish to think that older people would want to teach anything that was of value to psychiatrists only. These, then are the principles that I would like to share with you.

INSTITUTIONAL PLACEMENT FOR PATIENTS WITH ALZHEIMER'S DISEASE : HOW TO HELP FAMILIES WITH A DIFFICULT DECISION

Preview Families of patients with Alzheimers disease often want guidance from the patients physician on whether to put the patient in an institution. When is institutional placement indicated? What types of facilities are available? What should family members took for in a facility before and after placement? Dr Pfeiffer provides the answers to these and other questions raised by families facing this difficult decision.

The Need for Faculty Development in Geriatric Medicine

These remarks are presented as an outgrowth of accelerating activity and mounting concern about mechanisms which will assure Americas elderly the kind of health care which is specifically responsive to their needs and circumstances. While the advent of Medicare and Medicaid have already decreased the financial barriers, and while any of the proposed programs of national health insurance will undoubtedly move us farther in that direction, the development of specifically trained health manpower to meet the health needs of the elderly is in no way addressed by these programs. For this reason, the leadership of the Gerontological Society, the American Geriatrics Society, and the American Medical Association have been striving to focus on specific additional goals which will bring us nearer to the provision of good health care for older Americans through administrative or legislative remedies for this problem. I address myself specifically to the need for the development of medical school faculty in the field of geriatric medicine. The basic professional curricula of the core professions providing medical care to aging patients (Family Medicine, Internal Medicine, and Psychiatry) contain little or nothing specific to working effectively with the specialized aspects of care of the aging. In view of the growing number of elderly persons in this country (this is the fastest growing segment of our population), and in view of the greatly increased requirement for medical services on the part of older patients (in dollar terms, three times as much as for persons under age 65), the present situation must be changed on a highpriority basis. How can this change be accomplished? There are many possible responses to this question, several of which are being pursued by individual professionals working in the field of aging, and by professional organizations, specialty groups, medical specialty boards, the me-

What's new in Alzheimer's disease?

PreviewWhile certain important facets of Alzheimers disease—specifically, causes and preventive measures—remain to be discovered, progress has been made in diagnosis and management. Dr Pfeiffer describes the techniques now available to aid in accurately identifying this condition and outlines the many resources that can ease the way for the Alzheimers patient and his or her family caregivers.

A. Forensic Psychiatry

Forensic psychiatrists must balance the needs of each person assessed and/or treated with the risks of harm to others, including the person’s own family and associates, criminal justice or health service staff or the wider public. They most commonly provide treatment in a secure hospital environment, but may deliver services to prisons or deliver specialist community services. Generally, their patients are subject to legal restrictions.