Margaret E. Adamek

Managing Depressed and Suicidal Geriatric Patients: Differences Among Primary Care Physicians

This study examined differences by specialty of primary care physicians in managing suicidal and depressed geriatric patients. A probability sample of 300 Illinois physicians drawn from the American Medical Association Physician Masterfile was surveyed. Significant differences were found between specialties in estimates of the prevalence of psychiatric disorders; use of assessment procedures, treatment approaches, and referrals; perceptions of obstacles to providing mental health care; and confidence in diagnosing and treating depression and suicidality. Meeting the mental health needs of the rapidly growing older population will require a greater emphasis on geriatric mental health and consistency across primary care specialties.

Firearm suicide among older women in the U.S

Contrary to the common view that older women (65+) in the United States use suicide methods that have relatively low potential for death, firearms have become the most common suicide method in this group. The present study examines the association between demographic and geographic factors and the use of firearms vs other suicide methods. Data were derived from the National Center for Health Statistics (NCHS) Mortality Detail Files (1989-1991). Results from a logistic regression analysis indicate that among white women 65 and over who died by suicide in 1989-1991, the risk of using firearms varied significantly across demographic and geographic subcategories of the population. The following characteristics among women were significantly more likely to be associated with the use of firearms as a suicide method: ages 65-74, married, of lower educational attainment, in nonmetropolitan areas, and in the South. Research is needed to assess the effects of limiting firearms on the growing proportion of firearm-related suicides among older women.

Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners

Objective: This study sought to describe patterns of mental health care for depressed and suicidal geriatric patients by primary care physicians (MDs) and nurse practitioners (NPs). Methods: A probability sample of 300 Illinois MDs from the AMA Physician Masterfile and a national sample of 595 NPs from the American Academy of Nurse Practitioners were surveyed. Sixty-three percent of MDs and 61 percent of NPs responded regarding their approaches to assessing, treating, and referring older adult patients who were depressed or suicidal. Respondents rated their confidence in assessing and treating depression and suicidality and identified barriers to mental health treatment in a primary care setting. Results: Both similarities and differences were found among MDs and NPs in their patterns of managing depressed and suicidal older adults. NPs used more varied approaches in assessing, treating, and referring their geriatric patients with mental health problems. MDs relied more heavily on psychotropic medications for the treatment of depression and on psychiatrists when referring suicidal older patients. NPs were more likely than MDs to note lack of training and referral resources as barriers to treating depression of older patients. NPs rated their training in geriatric mental health more favorably than MDs. Conclusions: In terms of assessment of depression, preferred treatment approaches, the use of referral resources, and perceived barriers to mental health care, there appears to be a greater orientation towards a psychosocial approach among NPs. Primary care MDs and NPs often have different perspectives that in combination could enhance the mental health care of geriatric patients.

Research on older families when more than one member responds: Producing and interpreting findings

Abstract This article draws on data collected from a very old parent and two of her or his adult children in 20 older families to show how different strategies for analyzing data produce different images of families. The findings produced by means of five different analytical techniques are presented and compared. The degree to which each captures the reality of these older families is evaluated. The intent of the article is not to present findings but to show how different methods of data colletion and anlaysis create different images of older families.

The return migration experiences of Ethiopian women trafficked to Bahrain: ‘ … for richer or poorer, let me be on the hands of my people … ’

ABSTRACT This study draws upon the return experiences of Ethiopian women trafficked to the Middle East. Understanding these experiences is critical to informing the design of effective government policy to mitigate obstacles to return and reintegration. This study was conducted in Addis Ababa with five women who were trafficked to Bahrain and later returned to Ethiopia. Action research was used to establish an inquiry group of women in order to produce a viable vision for successful reintegration. Despite initial high hopes, the returnees did not see migration as producing positive returns. All five participants agreed that their experiences in the destination were devastating and thus they were relieved to have returned to their home country. Nonetheless, reintegration was a difficult process for them. In addition to not accumulating enough savings to enable them to reintegrate economically, they all faced misunderstandings and impractical expectations from their families and community. The women suggested that adequate protection from law enforcement, facilitation of income-generating activities, and improved access to rehabilitation and medical services are important elements of successful return and reintegration. Effective return and reintegration policy is needed to ensure that trafficked returnees can become productive citizens in their home country.

Chapter 7; Depression and Anxiety

SUMMARY Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.

Building Scholarly Writers: Student Perspectives on Peer Review in a Doctoral Writing Seminar.

Peer review was used as a primary pedagogical tool in a scholarly writing course for social work doctoral students. To gauge student response to peer review and learning as a result of peer review, the instructor used narrative analysis to organize student comments into themes. Themes identified included initial trepidation, “no pain, no gain,” and writing as relationship. Students transitioned from cautious reluctance about peer review to embracing it as a necessary part of the writing and publication process. As a profession that values collaboration, social work doctoral programs may benefit by encouraging peer support to enhance student writing and scholarly productivity.

Treating Unemployed Adolescents

Young people who cannot find jobs to confirm their adult status often develop dysfunctional behavior patterns and low self-esteem. In treatment, interventions focusing on job opportunities have been found to help more than interventions focusing on psychological issues.

Social Work Should Be More Proactive in Addressing the Need to Plan for End of Life

Social work should be more proactive in addressing the need to plan for end-of-life Kimberly J. Johnson, Ph.D. LCSW (corresponding author) Michin Hong, Ph.D., Megumi Inoue, Ph.D., MSW, RN, and Margaret E. Adamek, Ph.D Abstract Few people engage in planning for life’s end and the prevalence of preparedness is particularly low in ethnic communities. As a profession, social work is well equipped to help increase planning for life’s end and the care people wish to receive. However, the profession cannot simply defer to those in hospice and palliative care settings to address this issue. There is a need for earlier and equitable access to death preparation, and social workers can be instrumental in helping to insure equal opportunities for proactive planning for death. The ways social work may become more proactive in assisting individuals and families to prepare for the end-of-life are discussed.

“We Prefer Greeting Rather Than Eating:” Life in an Elder Care Center in Ethiopia

In Ethiopia where family care is a centuries-long tradition, living in an elder care institution invariably brings social devaluation. Accordingly, this study explored the psychosocial needs of older adults in a residential elder care center in Ethiopia from the perspective of both staff and residents. Three focus group discussions of 24 residents and interviews with 5 staff persons revealed that elders were living a subsistence lifestyle, eating the same meal every day, mostly cutoff from the surrounding community, and lacking basic amenities. Despite the absence of basic amenities, residents yearned even more so for meaningful social interaction. Psychosocial support was both undervalued and underutilized by staff members, and thus, residents’ psychosocial well-being appeared to be at risk. The addition of social workers in institutional care in Ethiopia may help to promote improved living standards. Advocacy is needed on behalf of residents to establish and implement guidelines on care and support of residents in old age homes. As elders in developing countries are living longer--a growing number with disabilities--at the same time that informal supports are waning, the need for developing long term care policies is becoming critical.