My recently published book, Psychological Treatment of Older Adults: A Holistic Model, is an attempt to outline what is most clinically apt for clinical health care providers when addressing the needs of older adults; principally to address the biopsychosocial needs of the older adult efficiently and effectively. We provide a research-based and clinically-practical understanding of five core factors of psychosocial impairment in older adults:
3. Cognitive deficits
4. Adjustment or life problems
5. Health issues
These provide, we believe, an adequate understanding likely to result in successful outcomes for common syndromes or problems at later life. Yes, this is a “whole person” model of care rather than assessing and treating symptoms or syndromes in isolation.
The key here is not just these “just-sufficient” factors but a deliberative Watch and Wait model where treatment occurs in a careful case-based assessment and a considered monitoring for empirically supported interventions. This model trumps the usual shoot-from-the-hip interventions, seeking quick cures. Each factor is addressed from its empirical supported influence as applied to older adults, as well as its interaction with the other factors. Distinct treatment modules are isolated for each factor and reasonable pathways to clinical problems are provided.
We also address the unique difficulties of diagnosing the aging population, the pitfalls of existing treatments, and the need for brain-based and practical models for care. Covered are the importance of primary medicine, issues of daily life adjustment, use of SSRIs and other medications, suicide, subsyndromal states, the use of cognitive behavioral therapy and the importance of cognitive training, promising models of caregiving and long-term care, as well as the psychological treatment of older adults from an economic perspective. Plentiful case examples and call-outs enhance information.
In the last 10 years there remains a vacuum as results from trends have been enlightening but disappointing. There is, we believe, a taxonomy crisis in psychiatry. The new DSM-5 is a just a model of constructs, some say a mess. At the core confusion reigns, especially regarding cognitive decline and depression/anxiety. Similarly, there is a revolution in psychotherapy. Long gone are adherence and allegiance to psychotherapy schools.
In this book we seek to finesse an exclusively medical focus. We have legions of psychiatric disorders, which disorders only recur, so relapse is a natural part of the phenomenon. We hope to present a clear case-based, person-centered approach that holistically leads to the application of best evidence.