Jeffrey Buchanan

Elder Abuse: Guidelines for Treatment

Publisher Summary Significant progress has been made in the past decades both in terms of acknowledging elder abuse as a social problem and in terms of understanding some of the possible causes and consequences of elder abuse. The excessive demands or “exhausted caregiver” theory proposes that the stress of providing care to an elderly person increases the risk that the caregiver will behave in an abusive manner. Ageism refers to attitudes toward the elderly that are characterized by a lack of valuing. Such prejudicial attitudes may lead to abusive behavior because the needs or rights of the elderly are seen as less important than the needs or rights of other people, particularly the caregiver. Elderly people who abuse substances are at greater risk for being abused than those who do not. Dependence of the caregiver on the care recipient, typically financial, has been associated with an increased probability of physical and psychological abuse. The purpose of screening is to determine whether an elderly person may be at risk for abuse. In addition to employing screening instruments, it is often useful to note the quality of interactions between the elderly person and the caregiver, if he or she is present.

Presentation of preferred stimuli as an intervention for aggression in a person with dementia.

Aggressive behaviors in elderly nursing home residents increase the risk of injury and stress for both residents and staff. Aggression is commonly treated with antipsychotic medications despite the risks of serious iatrogenic effects. This single-case design study evaluated a nonpharmacological intervention that involved making a preferred item continuously available and regularly orienting the participant to that item during caregiving sessions. The presentation of preferred stimuli was effective in reducing both physical and verbal aggression in the resident. The findings are significant, given the paucity of studies on nonpharmacological, restraint-free interventions for aggressive behaviors in elderly persons with dementia.

Clinical Psychology Curriculum and the Industrialization of Behavioral Healthcare

This chapter discusses the clinical psychology curriculum and the industrialization of behavior healthcare as discussed by Pallak. According to this chapter, current curricula tend to focus on the individual as the unit of analysis. Programs essentially train students to be craftspeople in an outdated, cottage industry model of behavioral healthcare delivery. With the rise of managed care, however, psychologists are confronted with a much larger unit of analysis—namely, an organized care system. The prospect of expanding from an individual to a systems level may at first appear daunting; the task is largely one of applying methods of clinical science to larger units of analyses. The chapter provides an outline of some of the issues that emerge when ones unit of analysis is a system as opposed to an individual. This chapter focuses the attention to the modification of clinical science curricula. The chapter concludes that many training programs may need to modify training in research methods to include these other methodologies that are more applicable to a systems level unit of analysis.